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Volume 20, No. 3 Autumn 1999

Thyroid Foundation of Canada

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

Dr. Robert Volpé, as a member of TheEndocrine Society received the following letter.

August 18, 1999

Dear Member:I’m writing to alert you to a major

news story, which has significantimplications for endocrinologyprofessionals.

At 5pm (EST) today, the NewEngland Journal of Medicine August19th, Volume 341, Number 8, willpresent the findings of a recent studywhich report that maternal thyroiddeficiency causes developmentalproblems for the child. The study, byDr. James E. Haddow, MD andcolleagues has significant implicationsfor all pregnant women who haveundetected, untreated hypothyroidism.

Dr. Haddow’s research teamretrospectively tested serum samples forevidence of hypothyroidism in a groupof 25,216 pregnant women whodelivered babies between 1987 and1990. From these samples, theyidentified 62 women who had beenhypothyroid during pregnancy. Theirchildren, who were ages 7 to 9 at thetime of the study, were examined forpossible neurological or psychologicaleffects of hypothyroidism in utero. Abattery of tests for attention, language,reading, and visual-motor performancewere administered and the results werecompared to those of a carefullymatched control group of childrenwhose mothers were not hypothyroidduring pregnancy.

The children of the mothers who hadbeen hypothyroid during pregnancy

performed less well on all tests. Theirmean IQ was reduced by 4 pointscompared to the control group. LargerIQ differences were seen in childrenborn to a subset of mothers who neverreceived any thyroid hormone treatment(mean IQ decreased by 7 points).Among this group, 19 percent of theoffspring had an IQ less than 85 asopposed to 5 percent of children in thecontrol group. This report confirms thefindings of several earlier, smallerstudies and it suggests that undiagnosed,untreated thyroid hormone deficiencyduring pregnancy adversely affectsbrain development.

The Endocrine Society believes thisstudy has important implications for themanagement of thyroid disease before andduring pregnancy. On behalf of itsmembers, The Society will issue a pressrelease and policy statement, whichincludes the following recommendations:

• A cost-effective strategy forscreening pregnant women forhypothyroidism before or early duringpregnancy. This will require furtherresearch to determine when screeningshould take place relative to conception,the method of testing, diagnostic criteriafor maternal hypothyroidism, treatmentguidelines, and the cost of screening.

• For now, women with a personal orfamily history of thyroid disease, orsymptoms suggestive of hypothyroidism,should be screened using TSH levelswhen they are planning pregnancy, or assoon as possible after conception.

• Women who are found to behypothyroid during pregnancy shouldbegin thyroid hormone replacementimmediately to provide adequate thyroidhormone levels to the developing fetus.

• Thyroid hormone requirementsincrease by about 25%–50% during

pregnancy. Consequently, women withknown hypothyroidism should have theirthyroid hormone levels monitored duringpregnancy, and appropriate adjustmentsof thyroid hormone replacement shouldbe made.

The Endocrine Society has begun tocontact allied organizations to reach aconsensus about how best to address thisimportant issue - at the physician,patient and consumer level.

As President of The EndocrineSociety, I will continue to keep youapprised of all developments on thisissue and may even call on you to lendyour expertise to what may become oneof the most important issues for TheEndocrine Society.

You may review The EndocrineSociety’s news release, positionstatement, and a list of “FrequentlyAsked Questions” at www.endo-society.org/maternalthyroiddeficiency/.

Again, I am pleased to provide youwith firsthand information on this fast-breaking news story and of TheEndocrine Society’s response.

Sincerely, J. Larry Jameson, M.D., Ph.DPresident, The Endocrine Society

2 thyrobulletin, automne 1999

As the second millennium comesto a close and a new one is about to begin,it is an appropriate time to review ouraccomplishments in the ThyroidFoundation of Canada (TFC). TheFoundation has grown through thecontinuing inspiration of our Founder,Diana Meltzer Abramsky, and thededicated volunteers who took up this

work on behalf of thyroid patients twenty years ago in Kingston. Today TFC is astrong and vital organization, reaching into every province, with twenty-two chaptersacross the country.

TFC’s Health Guides for thyroid patients, which cover many aspects of thyroiddisease, are available in both official languages, in print and also on our award-winningwebsite. Over the last two years, TFC has developed the Thyroid AssessmentQuestionnaire (TAQ) for distribution to the general public to promote early diagnosisby improving patient/physician communication. TFC’s successes should give us asense of pride in this hardworking organization.

Although a great deal has been accomplished, there is much yet to be done.Communities need chapters. Assistance to enquirers, whether by phone, fax, e- mailor snail mail, must be improved. Educational materials have to be expanded to includerecent findings, such as those of the New England Journal of Medicine, August 19,1999, which states that maternal thyroid deficiency causes developmental problemsfor the child.

Looking to the future, there are many questions which need to be addressed. Hereare some examples. Should TFC lobby for Canada to adopt the Endocrine Society’srecommendation that all pregnant women be screened for hypothyroidism? ShouldTFC advocate routine thyroid screening tests for women 50 and older? When thyroiddrugs have been recalled by the U.S. Food and Drug Administration, should TFCurge Health Canada to recall those drugs in this country? What can be done to protectCanadians from inferior thyroid drugs? What can be done to speed up availability ofnew thyroid medications to Canadians? Are alternative and non-traditional therapieseffective? Are they dangerous to thyroid patients? Is treatment with T3 (triidothyronine)the answer to the often-asked question, “Why don’t I feel well now that my test resultsare normal?” Could it be that the patients were right after all?

Acting effectively in these and other areas, means extending our research capabilitiesand sharpening our advocacy skills. We will require experienced and knowledgeablevolunteers who will devote their time and expertise to exploring the answers to thesequestions.

Promoting the importance of thyroid disease as a significant health issue, improvingsupport services for people coping with thyroid disease, and enhancing the knowledgeof healthcare professionals about thyroid disease will require additional humanresources and increased funding. Will you roll up your sleeves and help? Will youtake out your chequebook and give financial support? There is so much to be done tostrengthen and build the Foundation, please consider doing both.

That’s right. Tell us how thyroiddisease has changed your life,how you’ve adapted to live anormal life.

Tell us about the struggles you’vehad to face, the mountains you’veclimbed.

Send in your life story preferablyon disk or by e-mail along withphotos of you and your family andfriends and we’ll make everyeffort to run it in an upcomingissue of thyrobulletin.

Send your life story to:

Ed Antosz973 Chilver Road

Windsor ON N8Y 2K6Fax: (519) 971-3694

E-mail: [email protected]

We are lookingfor your story!!

Racontez nousvotre histoire!!

Quelles changements avez voussubit dans votre vie à cause devotre maladie thyroïdienne etcomment avez vous adapté unevie normale?

Racontez les difficultés que vousavez enduré durant ce temps.

Faites nous parvenir votre histoireainsi que des photos de votrefamille, vos amis et de vousmême, préférablement sur disqueou par courrier électronique. Nousferons de notre possible d’inclurevotre histoire dans uns desprochains numéros.

Faites parvenir votre histoire à:

Ed Antosz973 Chilver Road

Windsor ON N8Y 2K6Fax: (519) 971-3694

E-mail: [email protected]

President’smessage

Arliss Beardmore,National President

If you are eating: ................................ It should be the size of:1 medium bagel .................................. A hockey puck2 cups green salad ............................... A videotape2 tbsp. salad dressing .......................... A ping-pong ball1 medium orange or apple ................... A tennis ball3 oz. meat or fish ................................ A deck of cards1 cup pasta or rice ............................... A baseball1 oz. cheese ........................................ 4 dice

Helpful suggestions for estimatingportion sizes when dining out

thyrobulletin, Autumn 1999 3

16 September 1999

His Excellency The Right Honourable Roméo LeBlancGovernor General Of CanadaRideau Hall1 Sussex DriveOttawa, Ontario, K1A 0A1

Your Excellency:

As Founder of the Thyroid Foundation of Canada I amwriting to thank you for the gracious manner in whichyou honoured the Foundation as Patron.

We were especially pleased when you took the time inyour very busy schedule to visit and address our Sudburythyroid chapter.

On behalf of the Foundation I wish to convey to youand Her Excellency our best wishes for a healthy andhappy retirement. On my own behalf, as a Member ofthe Order of Canada, I would like to express my thanksfor the beautiful Christmas cards I have received fromYour Excellencies.

Yours truly,

Diana Hains Meltzer Abramsky, C.M., B.A.

Rejoice in the Holiday Spirit.May the New Millennium bring with it

Health, the Foundation of all Happiness.

La Fondation canadienne de la Thyroïdevous souhaite un Joyeux Noël et uneBonne et Heureuse Année et que le

nouveau millénaire vous apportela bonne santé.

The National Board and StaffL’équipe nationale

***************

National Office Christmas hoursThe office will be closed from

Thursday, December 23rd,1999at 4:30 pm

toTuesday, January 4th 2000

at 8:30 am

Can you please tell me if you have ever come across anyonein your society who has a lingual thyroid. I was born withthis defect (gland embedded in the base of the tongue). Thiswas removed 2 years ago but I am still having problems.

Lyn Thipthorp, Truro Cornwall UK

I have several patients with lingual thyroids. This is adevelopmental defect whereby the thyroid, which ordinarilystarts at the base of the tongue never moves forward into theneck. We treat lingual thyroid by giving patients thyroxinewhich suppresses the thyroid and it shrinks down. I have hadabout twenty patients in my practice with lingual thyroidsover my long career and we have not required surgery forany of those patients since their thyroid shrank nicely onthyroxine medication. The patient comes from Cornwall butshe might go to see Dr. John Lazarus in Cardiff, Wales orDr. Tony Weetman at the University of Sheffield, Sheffield,England, for further advice.

Would it be possible to ask a question concerning the newthyroid pill that I have recently been changed to. I sufferfrom hypothyroidism. I was on levothyroxine (0.125 mg) forthe last 3-4 years or so. My doctor has since placed me onCytomel (liothyronine 5 mcg twice daily). I understand thatthis drug has been given approval to be sold in Canada again.My questions are:1. What is the difference between levothyroxine and

liothyronine (Cytomel)?

2. Why was Cytomel taken off Canadian shelves and why isit now available in Canada?

3. How will I benefit from Cytomel as opposed tolevothyroxine?

I was the one who asked my doctor to switch medicationsbecause a friend of mine is on Cytomel and has never feltbetter. She’s more energetic and actually has lost weight.

Cindy-McLennan Warren, Maberly ON

In response to this question, I should tell you that thethyroid gland manufactures two thyroid hormones, namely,L-Thyroxine (T4) and L-Triiodothyronine (T3). The majorthyroid hormone (T4) actually breaks down to T3, such thatmost of the T3 in the body comes from this breakdown. Thus,when you give a tablet of T4, the T3 levels will be normal. T3is the same as liothyronine (Cytomel).

Lettersto the doctorRobert Volpé, MD, FRCPC, MACP,Medical Adviser to the Foundation

con't page 5

Thyroid Foundation of CanadaLa Fondation canadienne de la Thyroïde

Founded in/Fondée à Kingston, Ontario, in 1980

Patron

Diana Meltzer Abramsky, CM, BA

Board of Directors

Founder – Diana Meltzer Abramsky (ON)President of each Chapter (currently 22)

President – Arliss Beardmore (BC)Secretary – Stephen Clow (ON)

Treasurer – Allan Cruikshank, CA (QC)Vice-Presidents

Chapter Organization & Development – Joan DeVille (ON)Education & Research – Nora Hockin (ON)Publicity & Fundraising – Keith Attoe (ON)

Operations – Irene Britton (NB)Past President – Donald McKelvie (NB)

Members-at-LargeMarc Abramsky, Ed Antosz, Ellen Garfield, Nathalie Gifford,

Phyllis Mackey, Rita Wales

Annual Appointments

International Liaison – Diana Meltzer Abramsky, CM, BALegal Adviser – LouAnn Chiasson, BA, LLB

Medical Adviser – Robert Volpé, MD, FRCPC, MACP

Thyroid Foundation of Canada thanks Health Canada for its financial support.Thyroid Foundation of Canada is a registered charity – number 11926 4422 RR0001.

La Fondation canadienne de la Thyroïde remercie Santé Canada pour son supportfinancier. La Fondation canadienne de la Thyroïde est un organisme de

bienfaisance enregistré numéro 11926 4422 RR0001.

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: Jaunary 3, 2000

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 3 janvier, 2000

Contributions to/à – Editor/Rédacteur: Ed Antosz973 Chilver Road, Windsor ON N8Y 2K6

Fax: (519) 971-3694E-mail: [email protected]

Thyroid Foundation of Canada

thyrobulletinLa Fondation canadienne de la Thyroïde


Your membership in theFoundation expires on the datethat is printed on the address

label on your thyrobulletin.

Please use theMembership/Donation Form

in thyrobulletin.

You may renew early – and forone or two years! You will becredited with renewal on the

date that you are due to renew.

. . . Donations arealways welcome.

NOTICE TOALL MEMBERS

• 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 remasser les fonds pourla recherche sur les maladiesthyroïdiennes.

The objectives of theFoundation are:


When one gives T4, it invariably breaks down to T3, and levels of T3 will be normalwhen the dosage of thyroxine is appropriate. There thus does not appear to be good reasonsfor giving added T3, since it only increases the levels of T3 greater than normal, whichdoes not appear to be any advantage at all.

However, recently there has appeared in the medical literature an article suggestingthat the addition of T3 would make people feel better. However, at the same time, it isincreasing levels of T3 above normal, and this may not be beneficial to people over the longrun. For most endocrinologists, the idea of giving added T3 has not achieved any favourand we are generally worried about giving added T3.

T3 works much more quickly than T4, but it is gone much more quickly. Thus givingCytomel (T3) alone will not maintain stable thyroid hormone levels in the patients. Asmentioned above, adding T3 to T4 also has no advantages, as it merely increases the levelsof T3 above normal, and this may produce cardiac complications many years down theline.

The reason why Cytomel (T3) was taken off the Canadian shelves was merely a distributionproblem of the companies involved. This distribution problem has now been solved, and themedication is back on the shelves as before.

As to your question as to whether you will benefit from Cytomel as opposed to L-thyroxine,there is no intrinsic advantage to Cytomel, and any effect that it might have to make youfeel better is probably by making you a little bit hyperthyroid, which as I have stated above,may be a disadvantage over the many years that you will be taking it.

Letters to the doctor . . . con't from page 3

by Larry Wood

Today, as part of the advances in modernmedicine, there are many common screeningtests which are indicators of good health orpotential health problems. These include testsfor cholesterol as a measure of risk for heartdisease, a blood sugar test to detect diabetes,and a PSA level test which indicates in menthe risk for prostate cancer.

Fortunately, there is also a thyroid testwhich tells you whether your thyroidhormone levels are right for you. It is calleda TSH test (thyroid stimulating hormone) andconsists of taking a small amount of bloodwhich is then sent to a laboratory for analysis.All thyroid patients should know their testresults and what these numbers may indicate.

For example, if you have too much thyroidhormone in your blood (hyperthyroidism),your pituitary gland senses this and decreasesthe production of TSH. If, however, yourthyroid hormone level is low (hypo-thyroidism), your TSH levels will be high asyour pituitary gland tries to stimulate thethyroid gland to produce more hormone. It isa bit like turning the thermostat up or downif the house is too cold or too hot.

The TSH test is the single most importanttest to screen for hyper or hypothyroidism,and the only reliable way to tell if your dose

of thyroid hormone is right for you. If you arehypothyroid and taking thyroid hormone, yourTSH should be in the normal range. In manylaboratories this is 0.5 to 5.0 microunits/ml butyou should check the laboratory’s normalrange as some assays vary in their sensitivityand range of normal values. The normal rangemay also vary somewhat from country tocountry. If your TSH results are outside thenormal range, further tests of T3 and T4hormones may be in order.

If you have thyroid cancer, and yourphysician is giving you high doses of thyroidhormone to suppress the activity of cancercells, your TSH level should be low.

Whatever the situation is for you, be sureyou discuss your TSH results with yourphysician at the time of your regular check-ups and, above all, know your own TSHnumber and where it fits within the normalrange. Keep a record of the results of eachTSH test, note any major changes anddiscuss them with your doctor. Being wellinformed about your own condition is surelyone of the best ways to help yourself.

Lawrence Wood, MD, FACP, is President ofThyroid Federation International and theThyroid Foundation of America.

Reprinted with permission from ThyroWorld, thepublication of Thyroid Federation International.

Know your TSH

If you have not made yourwill yet, will you do it now?

Will you remember theThyroid Foundation of

Canada?

If you plan to update your will,will you do it now?

Will you help the ThyroidFoundation of Canada?

If we have helped you, willyou help us help others?

A bequest, an insurancepolicy, a tax exemptdonation – will you

think about it? Will youdo it now?


we received after the death of my brother. With our heartfeltthanks” Barbara Cobbe.

Important: London chapter members, watch forupcoming fund-raising events in year 2000.

MARYSTOWN CHAPTER

A public education meeting was held 25 October at theCollege of the North Atlantic. On 23 October we staffed aninformation booth and distributed the Thyroid AssessmentQuestionnaire.

We will be mailing a letter to all our former chaptermembers, encouraging them to rejoin the Foundation.

MONTREAL CHAPTER

In July, a two-page article was written on thyroid diseasein the French newspaper La Presse. The article attracted manypeople who then phoned our info line for more information.We responded to approximately 350 calls.

The Montreal Chapter took part in the Global Conferenceon Aging, 5 September – 8 September, which took place in aconference centre in downtown Montreal. We had a boothwhich enabled us to give out information on the ThyroidFoundation. Many thanks to all the volunteers. It was anexcellent opportunity for exposure and recognition of theFoundation.

On 21 September we held the first lecture of the season atthe Montreal General Hospital. Dr. François Gilbert spokeon Thyroid Disease. The lecture was in French, followed bya bilingual question and answer period.

THUNDER BAY CHAPTER

We welcome Darlene Ibey, new president of the ThunderBay Chapter, Susan Pagnotta having stepped down.

TORONTO CHAPTER

Lottie Garfield, community liaison, suggested to TVOntario that it include a segment on thyroid disease in itsnew Your Health program. On its initial program, Tuesday 5October, Dr. Robert Volpé and three of his patients talkedabout various aspects of hypothyroidism. The program, whichgave the Foundation’s 1-800 telephone number, was repeatedWednesday 5 October and Sunday 10 October.

On October 23, 1999, Dr. Robert Volpé, National MedicalAdviser addressed our education meeting at Sunnybrookand Women’s College Health Sciences Centre. His topic wasUnanswered Questions about Thyroid Disease.

Dr. Jay Silverberg, Head of Sunnybrook’s Department ofEndocrinology and Metabolism was present at the beginningof the meeting to explain some new research he is involvedwith regarding the use of T4 and T3 in the treatment ofhypothyroidism.

After the formal part of his presentation Dr. Volpé heldan informative Question and Answer session in which manypatient questions were answered. After the meeting there wasan orientation to greet and recruit new volunteers.

BURLINGTON-HAMILTON AREA

See Coming Events forNovember public meeting.

CALGARY AREA CHAPTER

We are seeking new members andvolunteers. Please call Marlene at

1-403-271-7811.

FREDERICTON AREA

An education meeting was held on Monday 18 October1999 in Room 222, D’Avray Hall, University of NewBrunswick. For more information regarding activities callColleen Smith: 506-455-6896. Please note her new phonenumber.

KINGSTON AREA CHAPTER

con't page 7

Dragon Boat Race: Pablo Paddlers, sponsored by theKingston Area Chapter.

Kingston Chapter sponsored a team, the Pablo Paddlersin the first Dragon Boats races held in Kingston, on 11September. This was a co-operative project: the chapterreceived publicity and the races raised money for HospiceKingston. Our team came in second in both races, quite anachievement for a group who had never paddled in DragonBoat races previously.

At the request of Nathalie Gifford, national membershipchairperson, chapter members prepared a mailing of 1500letters to lapsed members of the Foundation. They havevolunteered to assist in similar national projects in the future.

At the request of Arliss Beardmore, national president,Kingston members staffed the Foundation’s 1-800 line from9:00 am to 6:00 pm the week of September 27th to assessthe response to the advertisement in the Monday, September27th Women’s Health section of The Globe & Mailnewspaper.

LONDON AREA CHAPTER

“Chuck and I want all of our ‘thyroid family’ friends knowhow much we appreciated the many expressions of sympathy


With a smallgroup of

dedicatedvolunteers we

continue toprovide

outreach andrespond to asignificantly

increased number ofrequests for information and literaturefrom doctors, hospitals, libraries andcommunity health projects.

For more information about theseactivities and our education meetings,please call our help line: 1-416-398-6184.

VANCOUVER CHAPTER

We have moved. Our new mailingaddress is:

Thyroid Foundation of CanadaVancouver Area Chapter

Suite 187, 5525 West BoulevardVancouver, BC, V6M 3W6

Telephone number unchanged:(604) 266-0700

We are currently looking for morevolunteers. If you would be interestedplease contact us at our new address sothat we can contact you. Be sure toinclude your telephone number.

Renew your Membershipnow and become eligible

for our Monthly Draw

Every month one luckyRenewing Member will receive

a book on thyroid disease.

Our July 1999 winner was:May FarnsworthOttawa, Ontario

who chose “The Thyroid Sourcebook”

Sara Rosenthal

Our August 1999 winner was:Anne Ellis

Toronto, Ontariowho chose

“Your Thyroid: A HomeReference”

Wood, Cooper and Ridgway

Our September 1999 winnerwas:

Bernice LesterHanna, Alberta

who chose“Your Thyroid: A Home

Reference”Wood, Cooperand Ridgway

Monthly Drawthyrobulletin is

published four times a year:the first week of

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

February (Winter).

Deadline for contributions fornext issue (Winter):

January 3, 2000

Contributions to / à:Ed Antosz, Editor/Rédacteur

973 Chilver RoadWindsor ON N8Y 2K6

Fax: (519) 971-3694E-mail: [email protected]

* * * * *

Le thyrobulletin est publié quatrefois par année, la premiere

semaine de mai (printemps), août(été), novembre (automne) et

février (hiver).

La date limite pour les articlespour le prochain numéro

(hiver):

le 3 janvier, 2000

1. I had 3 meals today.

2. I allowed 4-6 hours between each meal.

3. I had at least a minimum number of servingsfrom each of Canada’s Food Guide’s four foodgroups:

• grain products 5 – 12 servings per day• vegetables & fruit 5 – 10 servings per day• milk products: servings per day

adults: 2 – 4 servingschildren (4-9 years): 2 – 3 servingsyouths (10-16 years): 3 – 4 servingspregnant & breast-feeding women:3 – 4 servings

• meat & alternatives 2 – 3 servings perday

Daily checkup4. I had something from 3 of the above 4 food

groups at each meal.

5. I had one or more starchy foods at each meal.

6. I made lower fat choices.

7. I selected a variety of high fibre foods.

8. I limited my concentrated sweets (if used) tosmall amounts with a meal.

9. I consumed sufficient fluids (not including tea,coffee and alcohol).

10. I did at least 20 minutes of exercise.


Burlington-Hamilton

Area

Tuesday 30November 1999

7:30 pmLiterature display 7:00 pm.

Dr. Hertzel GersteinDirector, Division ofEndocrinology and

Metabolism, McMasterUniversity, Hamilton, ONTopic: When the thyroid isnot doing its job: problems

and solutionsLocation: Joseph Brant

Memorial Hospital, BodkinAuditorium

1230 North Shore Blvd.,Burlington. Free parking.For more information call

1-905- 637-8387

Calgary Area Chapter

Saturday 13 November 19992:30 pm

Dr. Norman Wong,Endocrinologist

Topic: Hypothyroidismand pregnancy.

Location: University ofCalgary, Atrium of Health

Sciences Bldg., RoomG618,

3330 Hospital Drive N.W.Calgary (beside theFoothills Hospital)

March 2000:Date, speaker and topic TBA

May 2000:Date, speaker and topic TBA

For more information call1-403-271-7811

Kingston Chapter

Tuesday 15 November 19997:30 pm

Dr. Robyn Houlden,Endocrinologist

Topic: Radioactive iodinetreatment of thyroid disease

Tuesday 15 February2000

7:30 pmDr. Katherine Kovacs,

EndocrinologistTopic: Psychiatry and

the thyroid.

Tuesday 14 March 20007:30 pm

Speaker & Topic TBA

Tuesday 18 April 20007:30 pm

Dr. Robert W. Hudson,Endocrinologist

Topic: Nodules: benign &malignant – the manner ofpresentation, the manage-

ment and what one canexpect after treatment of

these diseasesLocation: Ongwanada

Resource Centre, 191Portsmouth Ave., Kingston

For more informationcall: 1-613-389-3691

Kitchener-WaterlooChapter


Dr. Cameron Purdon,Endocrinologist, Chapter

Medical AdviserOpen forum.

Topic: Living with thyroiddisease – a chance to getyour questions answered!

Location: Surrey StreetClinic, Guelph, Ontario

Saturday, 29 January 20002:00 pm

Hitesh Tailor, PharmacistKnoll Pharma Inc.

Topic: Thyroid disease andyour medication.Information table:

Michelle Donnelly, TerritoryManager, Knoll Pharma Inc.


Dr. Niloufer Saeed, FamilyPhysician & Haematologist,

Kitchener, Ontario Topic: Investigation &treatment of common

thyroid disorders as seen bya family practitioner.

Tuesday 2 May 20007:30 pm

Annual MeetingDr. Tom McDonald,

Chief of Endocrinology &Metabolism, London HealthSciences Centre, University

Campus, LondonTopic: Thyrotoxicosis

Location: TheCommunity Room, AlbertMcCormick Arena, 500Parkside Dr., Waterloo

For more informationcall: 1-519-884-6423

London Chapter


Dr. Thomas J. McDonald,Endocrinologist, UniversityHospital, Prof. of Medicine

Topic: Hyperthyroidism


Dr. Terri Paul,Endocrinologist, LondonHealth Sciences Centre,

University HospitalTopic: Thyroid diseaseand diabetes: what’s

the connection.

Tuesday 16 May 2000Speaker and topic TBA

Location: London PublicLibrary Auditorium, 305Queens Avenue, London.

Free admission, allwelcome, open to the

public.For more information call:

1-519-649-5478

Marystown Chapter:

March 2000more information later

Montreal Chapter

Wednesday17 November 1999

7:30 pm.Speaker & topic TBA

Wednesday16 February 2000

7:30 pm.PharmacistTopic: TBA

Wednesday 18 March 20007:30 pm.

Dr. J. Enrique Silva,Professor of Medicine &

Physiology, McGillUniversity

Topic: Recent progress inthyroid disease research.

Saturday 8 April toTuesday 11 April 2000Art exhibition and sale

Wednesday 17 May 20007:30 pm.

Annual meeting andelection

Location: Montreal GeneralHospital, Livingston Hall,

6th floorFor more information call:

1-514-482-5266

Ottawa Chapter

Tuesday 9 November 19997:15 for 7:30 pmDr. Erin Keely,

Associate Professor,Internal Medicine and

Endocrinology, Universityof Ottawa and Medical

Adviser to chapterTopic: Thyroid disease,

pregnancy and childbirth

con't page 9


Tuesday 15 February 20007:15 for 7:30 pm.

Dr. John Gay, Associate ProfessorEndocrinology, University of Ottawa

Topic: Thyroid disease andosteoporosis

Tuesday 18 April 20007:15 for 7:30 pm.

Annual General Meeting and PatientsPanel moderated by

Dr. Timothy O’Leary,Associate Professor of Endocrinology,

University of Ottawa.Location: Auditorium, Ottawa

Hospital, Civic Campus. All arewelcome. For more information call

1-613-729-9089

Présentation générale(en français)

jeudi, 25 novembre 1999à 19h30

Dr. Sandra Babin,endocrinologue, Centre hospitalier

régionale de l’Outaouais, auditorium,9ieme étage, Centre hospitalierrégionale de l’Outaouais, 116,boulevard Lionel-Émond, HullSujet: Maladies Thyroïdiennes:

Pour de plus amplesrenseignements, composer le

1-613-729-9089

Toronto Chapter

Mid-winter Meeting and Topic TBA

Location: Harrison Hall, LectureTheatre, Sunnybrook and Women’s

College Health Sciences Centre,

2075 Bayview Avenue,Toronto, Ontario.

For more information call:1-416-398-6184

Vancouver Chapter

For more information, call thehelp-line, (604) 266-0700

Questions from Hamilton Robert Volpé, MD,

FRCPC, MACP,Medical Adviser to the

Foundation

At an education meeting held inHamilton on 19 November 1998,time did not permit Dr. Hertzel

Gerstein, the speaker, to answer all thequestions posed by the audience. In thelast two issues (Volumes 20, No.1 & 20,No.2) Dr. Robert Volpé answered manyof these questions. In this issue heanswers the remaining questions.

PregnancyQ1. Can transient thyroiditis be

diagnosed at beginning of pregnancy?If only postpartum, what is the timeframe? Could it possibly be a yearpostpartum? What are the effects oftaking PTU on the foetus?

A. Transient thyroiditis can occur inearly pregnancy, but it is quite rare. Itcan be diagnosed by the presence ofappropriate symptoms, signs and bloodtests for thyroid function and thyroidautoantibodies. However, usuallythyroiditis presents in the postpartumperiod from 3-6 months after delivery,and then the condition itself may lastseveral months thereafter. A year afterdelivery is somewhat late for this event.As for the taking of propylthiouracilduring pregnancy, the dosage must belowered in the third trimester sincehigher doses could cause foetal goitreand foetal hypothyroidism. However,low doses are usually quite safe.

Q2. Is postpartum hypothyroidism tobe treated temporarily? Should yourdoctor take you off medication to see ifyour thyroid would return to normal?

A. Postpartum hypothyroidism canbe treated temporarily as this conditiongenerally only lasts for less than a year.The doctor could take a patient off themedication to determine whether thethyroid has returned to normal.However, there are reasons forcontinuing thyroxine forever in suchcircumstances. This is because there isa very high recurrence rate after futurepregnancies and this can be preventedby long term thyroxine therapy.

Q3. Is it normal to go frompostpartum hypothyroidism toHashimoto’s disease?

A. It is quite common to go frompostpartum hypothyroidism topermanent Hashimoto’s thyroiditis.After ten years, about half the patientswho had postpartum thyroiditis willhave Hashimoto’s thyroiditis.

Thyroid disease –miscellaneous

Q1. If high body temperature is causefor concern, what about low tem-perature? Is a consistently low bodytemperature a symptom of thyroiddisease, even if the tests are fine?

A. Low basal body temperatures areexceedingly common, and unless thepatient is deathly ill, generally do notmean much. Certainly a consistently lowbody temperature is not a symptom ofthyroid disease when function tests arenormal. This is a complete fallacy.

Q2. What does it mean to have apersistently low body temperature allthe time? Which is harder to diagnose– hyper or hypothyroidism? Why are thedoctors not cognizant of the symptomsof particularly hypothyroidism? Ifthyroid reading is in normal range, is itnormal for the person?

A. Once again, there is nosignificance to a persistently low basalbody temperature. This has beenpromulgated in the ‘marginal literature’and it has been even claimed that thisis a better test than the routine thyroidfunction tests. This is completely wrongas the thyroid function tests,particularly the TSH, are extremelysensitive. If all these tests are normal,then the thyroid itself is quite normal interms of thyroid function.

Doctors are quite cognizant of thesymptoms of hypothyroidism. Theproblem is that these symptoms are verynon-specific and can occur in a widerange of non-thyroidal diseases.Fatigue, malaise and lassitude areextremely common amongst thepopulation and usually do not signify

con't page 10


Questions from Hamilton . . . con't from page 9

hypothyroidism. If the thyroid function tests are within thenormal range, once again, particularly the TSH, then it isnormal for that person. It is true that there is a range ofnormal but if the TSH is within normal limits, then that patienthas normal thyroid function.

Q3. If one has liver abnormalities would it make sense togive T3 and T4 orally and not just levothyroxine?

A. Even with liver abnormalities, L-thyroxine converts totriiodothyronine quite normally. This occurs in many othertissues of the body other than the liver.

Q4. What is Cushing’s disease.A. Cushing’s disease is a disease of the adrenal glands

and has nothing to do with the thyroid. It is due to over activityof the adrenal glands, causing high blood pressure, roundingof the face and body, thinning of the skin, osteoporosis, andhigh blood sugars. It is a very dangerous disorder.

AutoimmuneEndocrinopathies

The University of British Columbia (UBC) inassociation with the Thyroid Foundation ofCanada (TFC), Vancouver General Hospital and

St. Paul’s Hospital has initiated an ‘early warning’thyroid project. It is expected to greatly improvedetection and therefore treatment of thyroid orbitopathy(Graves’ Orbitopathy).

Thyroid orbitopathy, the swelling and protrusion ofthe eyes, is a devastating autoimmune condition thathas a significant impact on the patient’s daily activitiesand quality of life. It is usually associated with (andoften develops following) hyperthyroidism, the mostcommon form of which is thyrotoxicosis or Graves’Hyperthyroidism.

The Thyroid Foundation of Canada gives aconservative estimate that approximately 1 in every 100Canadians is affected by this condition. Research hasshown that an estimated 60% of these patientsexperience some signs of orbitopathy. If these patientscan be reached early in the development of their disease,effective treatment may be used to lessen the impacton patient health.

A diagnostic tool designed to measure a patient’srisk of developing thyroid orbitopathy would providean effective method of raising awareness and improvingcontrol of the debilitating disease. The diagnostic toolwill take the form of a questionnaire, the ThyroidOrbitopathy Indicator (TOI).

Its contents will be developed through clinicianconsultation, patient focus groups and literaturesearches relating to Graves’ Orbitopathy. The resultingquestionnaire will be easy for the patient to understandand answer, brief to limit the burden on the patient’stime and patience, and straightforward foradministrators to score.

Once it has been designed, it will be tested onhyperthyroid patients recruited from VancouverGeneral Hospital and St. Paul’s Hospital. These patientswill be given a copy of the questionnaire, and clinicalassessments at regular intervals over an 18-monthperiod. Both UBC and TFC are enthusiastic about thisrecent thyroid initiative.

The study will be based out of the Vancouver GeneralHospital Eye Care Centre under the direction of JackRootman, MD, FRCSC, Professor of Ophthalmologyand Pathology, University of British Columbia. The TOIdevelopment coordinator is Mark Linder.

All inquiries concerning the project may be addressedto Mark Linder at 2250 Willow Street, Vancouver, BC,V5Z 3N9, Canada. Tel: (604) 875-4111, ext 62880 Fax:(604) 875-4663, E-mail: [email protected]

Reprinted with permission from ThyroWorld, publication ofThyroid Federation International.

Thyroid Orbitopathy IndicatorAn ‘early warning’ thyroid project

This volume on the subject of autoimmune endocrinediseases adds to the prolific output of Bob Volpé onthis subject. As a thyroid doctor, I am delighted to seethat there is such an emphasis upon autoimmune thyroiddisease, although there are major contributions oninsulin-dependent diabetes and other organ-specificendocrine diseases.

The authors of this text are some of the world leadersin this field, and bringing them together is a tribute tothe collaborations and friendships Bob Volpé hasestablished over the years. I especially enjoyed readinga summary of the genetics of diabetes and thyroiddisease by Terry Davies and his colleagues, as well asTony Weetman’s discussion of thyroid-associatedophthalmology and dermopathy, and a review of theepidemiology of thyroid disease by Mark Vanderpumpand Michael Tunbridge. I also learned a lot aboutsubjects with which I was much less familiar such asautoimmune adrenal, gonadal and pituitary failure.

I think this book provides an excellent overview ofcurrent knowledge on the subject of autoimmuneendocrine disease, and as such it is of great interest toendocrinologists with an interest in immunology, andindeed to the immunologist with an interest inendocrinology. I recommend it highly.

Jayne Franklyn. Reprinted from The Endocrinologist Newsletter,Society of Endocrinology, UK, Autumn 1999.

Edited by Robert Volpé, MD

Humana Press, Totowa, NJ, 1999.US$175. ISBN 0896036804


Anticorps: Molécules produites par les tissus lymphatiquespour neutraliser une substance étrangère.

Hormone: Substance produite par une glande et déverséedans le sang, ayant une action physiologique spécifique auniveau de divers organes.

Hyperthyroïdie: Maladie découlant d’une sécrétionhormonale excessive de la thyroïde.

Hypophyse: Glande située à la base du crâne. L’hypophyserégularise les processus de l’organisme et produit la TSH,ou thyréostimuline hypophysaire, hormone stimulant lasécrétion d’hormones par la thyroïde.

Hypothyroïdie: Maladie découlant d’une sécrétionhormonale insuffisante par la thyroïde.

Lévothyroxine sodique: Forme synthétique de la principalehormone sécrétée par la thyroïde. C’est le médicament leplus fréquemment prescrit dans les cas d’hypothyroïdie.

Ostéoporose: État caractérisé par une diminution de la masseosseuse. Les os affaiblis ou comprimés peuvent se fractureraux chocs mineurs ou, dans le cas de la colonne vertébrale,sous l’effet de la courbure.

Système immunitaire: Système de protection de l’organismecontre les germes étrangers.

Test de la TSH: Test sanguin simple utilisé pour déceler lesmaladies thyroïdiennes. La sécrétion de TSH(thyréostimuline hypophysaire) augmente or diminue en casd’anomalie de la fonction thyroïdienne. Ce test consiste àmesurer les concentrations d’hormone dans le sang pourdéterminer si la thyroïde fonctionne correctement.

Thyroïde: Minuscule glande en forme de papillon placée enavant de la trachée qui régularise la fonction des organes parl’intermédiaire des hormones qu’elle sécrète.

Thyroïdite de Hashimoto: C’est la cause la plus communed’hypothyroïdie. Il s’agit d’un trouble de la thyroïde, trèsfréquent chez les femmes d’un àge mûr, durant lequel desanticorps produits par l’organisme attaquent le tissuthyroïdien.

Glossary

Antibodies: Molecules produced by the lymph tissue toneutralize the effect of a foreign substance.

Hashimoto’s thyroiditis: Hashimoto’s is the most commoncause of hypothyroidism. It is a disorder of the thyroid gland,most common in middle-aged women, in which the body’santibodies attack the thyroid tissue.

Hormone: Chemical substances produced by the body’sglands to control the functioning of the body’s organs. Theyare carried by the blood.

Hyperthyroidism: A disease that occurs when the thyroidgland produces too much thyroid hormone.

Hypothyroidism: A disease that occurs when the thyroidgland does not produce enough thyroid hormone.

Immune system: The body’s system that protects it fromforeign organisms.

Levothyroxine sodium: A man-made form of the mainhormone produced by the thyroid gland. It is the mostcommon drug for treating hypothyroidism.

Osteoporosis: A condition of depleted bone mass. The resultis weakened or compressed bones that may be broken byminor injuries and/or curvature of the spine.

Pituitary gland: A gland situated at the base of the skull.The pituitary gland monitors the bodily processes andproduces Thyroid Stimulating Hormone (TSH), a hormonethat signals the thyroid gland to produce thyroid hormone.

Thyroid gland: A tiny butterfly-shaped gland located in frontof the wind pipe. It regulates your body’s organs through thethyroid hormone it produces.

TSH test: A simple blood test used to uncover thyroiddisease. Thyroid Stimulating Hormone (TSH) is a hormonethat rises or falls with abnormal thyroid function. This testmeasures TSH hormone levels in the blood to detect if thethyroid is working properly.

Glossaire

Mythe: la plupart des insuffisantsthyroïdiens sont obèses

Myth: most people with anunderactive thyroid are obese!


By Jody Ginsberg, MD, FRCPC

Medical Research is the only way toadvance our understanding about thecauses of thyroid disease with a view todeveloping new treatments. However,funding for research in thyroid diseaseis more threatened than ever!

Because of the economic climate, theamount of funding available for medicalresearch from government agencies hasdecreased in recent times.Unfortunately, thyroid research may bemore hard hit than other areas. Agenciescontrolling research funding want more“bang for the buck” and are naturallydirecting their resources to diseases withthe highest mortality rates such as heartdisease and cancer. Fortunately, thyroiddisease rarely results in death. However,research into the immunology of thyroiddisease or on how thyroid cells growmay have direct application into suchserious diseases as insulin-dependentdiabetes and cancer. The highprevalence of thyroid disease in thepopulation, its significant morbidity andeffect on workdays lost should promptfurther research into this area. As

Important reasons to supportthyroid research

government agencies become less ableto fund research into thyroid disease,private agencies such as the ThyroidFoundation of Canada will play anincreasing role in ensuring thecontinuance of thyroid-related researchin the future.

Here are some examples as to howthyroid research in Canada in recenttimes is benefitting patient care:• Drs. Jean Dussault in Quebec and

Paul Walfish in Ontario developedthe methodologies used in screeningprograms for congenital hypo-thyroidism. These techniques, nowapplied worldwide, have identified acongenitally hypothyroid infant in1:5000 births. Appropriate treatmentprovided early has prevented mentalretardation in these infants. Withoutresearch into how thyroid hormonemeasurements could be made fromblood applied to a filter paper spot,such programs would not beachievable.

• Dr. Robert Volpé in Toronto hascharacterized the nature of theimmune defect responsible forautoimmune thyroid disease. Hislaboratory is currently studyinganimal models in which thyroiddisease can be induced or caused toregress upon manipulation of theimmune system. Potentially, similar

manipulations of the immune systemin a patient prone to develop thyroiddisease may lead to the preventionof autoimmune thyroid disease in thefuture.

• Dr. Roger Rittmaster and colleaguesin Halifax are studying a protocol fortreatment of Graves’ disease. Basedon a similar protocol which wassuccessful in Japanese subjects, theseinvestigators are determining if sucha treatment could be applied toCanadians. If so, their study couldpoint to a different way of treatingGraves’ disease.

• Drs. Jack Rootman and DavidKendler of Vancouver are outliningthe natural history of thyroid eyedisease and how available and newtreatments should be applied.

These important projects could nothave been successful without supportfor medical research. The ThyroidFoundation, through its SummerStudentship and Fellowship programshas played a critical role in many ofthese and other important researchinitiatives.Dr. Ginsberg, Director, Division ofEndocrinology & Metabolism,University of Alberta, was MedicalAdviser to the Thyroid Foundation ofCanada 1993-1996.

To realize the value of one year:

Ask a student who has failed afinal exam.

To realize the value of one month:

Ask a mother who has givenbirth to a baby.

To realize the value of one week:

Ask an editor of a weeklynewspaper.

To realize the value of one hour:

Ask the lovers who are waitingto meet.

“Today is agift, that’swhy it is

called thepresent.”

To realize the value of one minute:

Ask a person who has missed thetrain, bus or plane.

To realize the value of one second:

Ask a person who has survived anaccident.

To realize the value of one millisecond:

Ask the person who has won asilver medal in the Olympics.

Time waits for no one.Treasure every moment you have.You will treasure it even more when youcan share it with someone special.


What’s that? Well, it is themost recent communicationinitiative undertaken by theThyroid Foundation ofCanada. It is a neat little ques-tionnaire that anyone can an-swer in a few minutes, thentake to their doctor as a talk-ing point to discuss their thy-roid concerns. A simple idea,but one that demanded greatorganization and hard work.

As the first lay thyroid or-ganization in the world, theThyroid Foundation ofCanada has always been at-tuned to the problems expe-rienced by thyroid sufferers.Through its contact withmany thousands of patients,it has become increasinglyconcerned about the problemof delayed diagnosis.

Patients may feel that theirsymptoms are not importantenough to mention to theirphysicians. Symptoms maybe attributed to signs of ag-ing, to menopause, to generalfatigue or the result of stress.Without the complete pictureof symptoms, however, thy-

roid disease can be over-looked. Patients experiencingthe effects of thyroid diseasemay need help communicat-ing with their physician. Ironi-cally, just when it is mostimportant to talk with the fam-ily doctor, thyroid sufferersmay be least able to do so. Theresult may be delayed diagno-sis and prolonged suffering.Left untreated, thyroid dys-function can lead to otherhealth problems, includingcardiovascular disease, oste-oporosis, anxiety and depres-sion. Early diagnosis iscritical.

The goal of the ThyroidAssessment Questionnaire(TAQ) project is improvedcommunication. The finalproduct is a professionallydesigned brochure, a well-tuned questionnaire devel-oped through the cooperativeefforts of volunteers, healthcare professionals,government, the privatesector, and the general public.

Government played a keyrole in launching this projectby providing the primarysource of funding which madeit possible to hire a ProjectManager, to evaluate theproject, and to document it forfuture use by other health or-ganizations.

Business sector partici-pants to whom we owe oursuccess and thanks are KnollPharma Inc. and MDS MetroLaboratory Services. The lat-ter donated blood testing andcollection services. Their em-ployees, in particular teamleaders Andrea Safavi andCheri Drew, Vancouver, vol-unteered their time and con-siderable expertise to conduct

Canadian initiative:

Thyroid Assessment Questionnairethree days of clinic activity.Knoll Pharma provided addi-tional funding and a wealth ofmarketing knowledge and or-ganizational support throughthe efforts of Product ManagerMahen Gundecha and MediaConsultant Barry Ashpole.

The general public in-volved in the project included30 focus group members,1200 clinic participants, andmore than 2,000 people at-tending TAQ forums and fieldtrials.

The TAQ is a work inprogress. Our initial effortsresulted in its successfullaunch, and the future holdsmuch more. Encouraged bythis success, the Foundationset up focus groups to developa French version of the TAQ.Plans are also underway for aTAQ to be developed in Van-couver for the Chinese popu-lation.

In addition to the Founda-tion’s excellent informationavailable for patients alreadydiagnosed with thyroid dis-ease, the TAQ is intended forthe general public to increaseawareness of thyroid diseaseand to facilitate communica-tions between the physicianand patient. If it succeeds indoing so, we will be wellpleased with our TAQ project.

An extract from ThyroWorld,publication of Thyroid FederationInternational

Souffrez-vous de fatigue,dépression, anxiété,changement de poidsinexpliqué, ou difficulté àtolérer la chaleur ou le froid?Ce sont tous des symptômescommuns des maladiesthyroïdiennes. Venez assisterà la première séanced’information publique enfrançais de la division de larégion d’Ottawa et recevezcopie d’un nouveau question-naire qui vise à faciliter lescommunications entre pa-tient et médecin et àaméliorer le traitement desmaladies thyroïdiennes.

Conférencière:Dr. Sandra Babin,

endocrinologue

25 novembre 1999à 7h30 p.m.

Auditorium, 9ième étage

Centre hospitalierrégional de l’Outaouais

116 boulevard Lionel-Émond, Hull, QC

Information: 613-729-9089

TAQ Press ReleaseIn conjunction with the print-ing and wide-spread distribu-tion of the TAQ this summer,Media Consultant, BarryAshpole, distributed a TAQPress Release across thecountry to the media: radio,television and the press.


Thyroid disease at a glance

Thyroid disease has many faces, yet all of its symptomsoriginate with trouble in the thyroid gland. The thyroidgland is a small, butterfly-shaped gland weighing only an ounce. But it is

also command central for many organs in the body, including the heart, brain, andliver. The thyroid gland also regulates metabolism and cell growth.

The thyroid gland secretes two major hormones, T4 (thyroxine) and T3(triiodothyronine). These hormones travel to the organs of the body via thebloodstream. When all systems are go, Thyroid Stimulating Hormone (TSH) isreleased by the pituitary gland, which triggers the production of T3 and T4.

When T3 and T4 are at the appropriate levels, TSH will level off as it should.However, if there is too little T4 and T3, TSH will be elevated. If there is toomuch T4 and T3, TSH will be suppressed. In this way, TSH is a marker of thyroidfunction and thyroid hormone levels.

Hypothyroidism – occurs when the thyroid gland is underactive and producesinsufficient thyroid hormone. It is the most common thyroid disorder, occurringmore frequently in women than in men. Hypothyroidism affects 6% - 10% ofwomen over the age of 65.

Treatment for hypothyroidism is straightforward. Synthetic levothyroxine (LT4)is a safe and effective thyroid hormone replacement therapy. In fact, it is one ofthe top three most commonly prescribed drugs in North America.

Hyperthyroidism – is a less common disorder affecting approximately 2%of women and .02% of men. It occurs when the thyroid gland is overproductive.The elevated T3 and T4 levels can have a dramatic impact on body functions,speeding up metabolism by 60%- 100%. Patients with hyperthyroidism havesometimes been described as being anxious to a point of not making sense.

There are a range of treatments available for hyperthyroidism, including anti-thyroid drugs, radioiodine treatment, and surgery. All are effective, though noone treatment ever results in a complete cure.

Thyroid cancer – fortunately, is extremely rare, accounting for less than 1% ofall cancers. Total or partial thyroidectomy is the only treatment option. If thecancer has spread to the lymph nodes, these must also be removed.

Nodules – about 5% of the population have ‘bumps’ on the thyroid gland knownas nodules. They are more common in women than in men and are probablycaused by low T3 and T4. Provided they are solitary, nodules have just a 5% – 10% chance of being malignant.

Recent thyroid cancersurvivor/singer

Singer Donna Mae, of StoneyCreek, Ontario, is thriving and not justsurviving, after having a bout withthyroid cancer. She has fully recoveredand is singing again, doing benefitshows to increase awareness ofthyroid cancer and to raise money forcancer research. A portion of herearnings is donated to the CanadianCancer Society.

Besides doing benefits, she alsoprovides encouragement, over theInternet, for others diagnosed withcancer. Her website is: http://www.geocities.com/Broadway/Wing/5603

Dear Donna Mae,Thank you very much for the press

clipping profiling your benefit concertthis past weekend in Stoney Creek. Ihave no doubt that the event of July4th was an overwhelming success. TheStoney Creek News article was excel-lent. I myself had an opportunity tohear the Stoney Creek concert an-nounced here in Hamilton via radio.

On behalf of the Canadian CancerSociety, please accept our sincere ap-preciation for all your hard work andcommitment in developing these ben-efit concerts to assist people livingwith cancer, and their families.

Ultimately, these are the true ben-efactors of your support. I am confi-dent that your Burlington performancewill be equally successful.

Regards, Kevin McDonald, Com-munity Outreach Canadian CancerSociety, Central West Region

The Thyroid Foundation of Canadawishes to welcome Yves Mayrand to thenational office staff. Yves will be theMembership Services Coordinator and looksforward to serving all the Foundation’smembers.

La Fondation canadienne de la Thyroïdesouhaite la bienvenue à Yves Mayrand àl’équipe du bureau national. Yves nous jointcomme coordinateur des services auxmembres et prendra plaisir à vous servir.

Thyroid Australia

Congratulations to Thyroid Australiaupon the publication of its firstnewsletter, THYROID FLYER. ThyroidAustralia, a newly formed nationalthyroid organization, was founded inMelbourne in June 1999. It is aimed atthe one in fourteen Australians who areaffected by thyroid conditions. The firstissue contains articles on IodineDeficiency Disorders, The Thyroid andIodine, Should Pregnant Women beTested. Welcome, Thyroid Australia, tothe ever-growing group of thyroidorganizations around the world.

Membership runs 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 membership/donation by:

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

THYROID FOUNDATION OF CANADA, 96 Mack Street, Kingston, Ontario K7L 1N9Tel: 1 (800) 267-5822 or (613) 544-8364 • Fax: (613) 544-9731 • Website: http://home.ican.net/~thyroid/Canada.html

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q Your Thyroid: A Home Reference - Wood, Lawrence C., MD,Cooper, David S., MD, Ridgeway, E. Chester, MD $21.00 $

q Thyroid Disease, The Facts - Bayliss, R.I.S., MD,Tunbridge, W.M.G., MD $27.00 $

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To order a book, complete this form and mail with your name, address and payment to Thyroid Foundationof Canada, 96 Mack Street, Kingston ON K7L 1N9, or fax with credit card details to (613) 544-9731.

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