One of Canada’s best thyroid doctors, Dr. Ron Matsusaki in Nova Scotia, has had his license to prescribe and treat thyroid suspended. His thyroid clinic in Digby has been under review for the past month, and the decision was announced on the clinic’s Facebook group April 17, 2019.(1)
Let’s do everything we can to speak out against medical Injustice.
This is not just an isolated, local problem. This is part of a global trend to limit thyroid therapy to one medicine and one test. (2-4)
Every good thyroid doctor in Canada is at risk (5). Every thyroid patient who suffers hypothyroidism on standard TSH-normalized therapy is at risk. Every patient’s T3-optimization is at risk. Every patient who uses Health-Canada approved desiccated thyroid medication is at risk of medical bias and fearmongering against their medication. (6-7; 13-14)
Blame the international stranglehold of the ATA therapy guidelines for hypothyroidism for falsely making the TSH the only guide and T4 monotherapy the only tool since the 1980s. (5, 8-9)
Blame biased research for limiting trials of T3 hormone therapy to insignificant doses and ratios, ensuring that T3 trials fail to show superiority over their favorite T4 monotherapy. (10) The key result that everyone ignores is that including T3 in our medication is proven to be equally safe and equally effective, (11) and occasionally more beneficial. (11b,c)
Blame Choosing Wisely Canada and the Canadian Society of Endocrinology and Metabolism for enforcing these rigid American policies that curtail thyroid hormone testing during thyroid therapy, especially Free T3 testing. (5)
Blame medical education for teaching narrow-mindedness and dismissal of patients’ chronic hypothyroid symptoms, (12) which often correlate with Free T3. (12b; 17)
Blame envious and jealous doctors who want to control their thyroid patients and prevent them from seeing anyone else who might improve their thyroid therapy. (31)
Blame the blindness of endocrinology as a profession for not yet acknowledging that the human body defines hypothyroidism as T3 insufficiency, not TSH excess. (15-17)
Blame our health care systems for not acknowledging that suboptimal T3 harms the health of every organ and tissue in the human body, including cardiovascular health (18-19) and mental health (20, 21). Low T3-T4 ratios are associated with all cause mortality in illness (22-23), frailty in the aged (24), Alzheimer’s disease (25), atherosclerosis (26), and a shorter lifespan (27, 28).
Ignorance of Free T3 hormone is deadly and unsafe.
Doctors like Dr. Matsusaki are being punished for their awareness of these health problems and for their exceptional ability to treat and prevent chronic low T3 syndrome in thyroid patients.
To clarify, nothing Dr. Matsusaki prescribed was off limits or intrinsically unsafe, and he did full testing of TSH, Free T3 and Free T4 and even Reverse T3 to ensure dosing yielded sufficient and safe levels of thyroid hormone.
He preferred prescribing desiccated thyroid, sold as Thyroid by ERFA, which is a Health Canada approved medication with a DIN#. (29) It can only be sold by prescription. Desiccated thyroid was the gold standard of thyroid therapy until about the 1970s. (8,9) It contains T3 and T4 hormone, both of which are secreted from a healthy human thyroid gland. It is medically equivalent to combining the two standard synthetic pharmaceuticals that contain T3 (Cytomel by Pfizer) and T4 (Synthroid / Levothyroxine) if they were dosed at a ratio of about 20% T3 to 80% T4. (30)
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(1) Announcement made April 17, 2019 by the administrator of the Digby thyroid clinic Facebook group.
(2) ThyroidChange. (n.d.). AACE/ATA Social Media Protest. Retrieved April 21, 2019, from ThyroidChange website: http://www.thyroidchange.org/aaceata-social-media-protest.html
(3) ThyroidChange. (2017, January 16). Study Confirms Thyroid Testing Beyond TSH and Revisits Treatment Options for Patients. Retrieved April 21, 2019, from ThyroidChange website: http://www.thyroidchange.org/2/post/2017/01/new-study-confirms-thyroid-testing-beyond-tsh-and-revisits-treatment-options-for-patients.html
(4) Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I. L., Mechanick, J. I., … Woeber, K. A. (2012). Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocrine Practice, 18(6), 988–1028. https://doi.org/10.4158/EP12280.GL
(5) Choosing Wisely Canada, Gilmour, J., & Mukerji, G. (2017, August). Less is more with T3 & T4: A toolkit for reducing free thyroid hormone testing. Version 1.0. Retrieved from https://choosingwiselycanada.org/wp-content/uploads/2017/09/CWC_T3T4_Toolkit_V1.pdf
(6) Shomon, M. (2018, December 3). Why Your Endocrinologist May Oppose Natural Thyroid. Retrieved January 4, 2019, from Verywell Health website: https://www.verywellhealth.com/why-endocrinologists-oppose-natural-thyroid-3882628
(6b) [Anti-desiccated article, sample 1: ] Harrar, S. (2017, November 7). What You Need to Know About Hypothyroidism Extract Medications. Retrieved April 21, 2019, from EndocrineWeb website: https://www.endocrineweb.com/conditions/hypothyroidism/natural-thyroid-extract-comeback
(7) [Anti-desiccated Fearmongering article, sample 2 : ] Barrett, S. (2013, September 10). Desiccated Thyroid: Be Wary of Doctors Who Prescribe It. Retrieved August 13, 2018, from https://www.quackwatch.org/01QuackeryRelatedTopics/armour.html
(8) Hennessey, J. V. (2017). The emergence of levothyroxine as a treatment for hypothyroidism. Endocrine, 55(1), 6–18. https://doi.org/10.1007/s12020-016-1199-8
(9) McAninch, E. A., & Bianco, A. C. (2016). The history and future of treatment of hypothyroidism. Annals of Internal Medicine, 164(1), 50–56. https://doi.org/10.7326/M15-1799
(10) Wiersinga, W. M., Duntas, L., Fadeyev, V., & Nygaard, B. (2012). 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism. European Thyroid Journal, 1(2). https://doi.org/10.1159/000339444
(11) Tariq, A., Wert, Y., Cheriyath, P., & Joshi, R. (2018). Effects of Long-Term Combination LT4 and LT3 Therapy for Improving Hypothyroidism and Overall Quality of Life. Southern Medical Journal, 111(6), 363–369. https://doi.org/10.14423/SMJ.0000000000000823
(11a) Bunevicius, R., & Prange, A. J. (2000). Mental improvement after replacement therapy with thyroxine plus triiodothyronine: relationship to cause of hypothyroidism. The International Journal of Neuropsychopharmacology, 3(2), 167–174.
(11c) Tariq, A., Wert, Y., Cheriyath, P., & Joshi, R. (2018). Effects of Long-Term Combination LT4 and LT3 Therapy for Improving Hypothyroidism and Overall Quality of Life. Southern Medical Journal, 111(6), 363–369. https://doi.org/10.14423/SMJ.0000000000000823
(12) [NOTE: This article discusses the common problem of dismissal of patients’ symptoms and attempts to address it] Kalra, S., & Khandelwal, S. K. (2011). Why are our hypothyroid patients unhappy? Is tissue hypothyroidism the answer? Indian Journal of Endocrinology and Metabolism, 15(Suppl2), S95–S98. https://doi.org/10.4103/2230-8210.83333
(12b) Larisch, R., Midgley, J. E. M., Dietrich, J. W., & Hoermann, R. (2018). Symptomatic Relief is Related to Serum Free Triiodothyronine Concentrations during Follow-up in Levothyroxine-Treated Patients with Differentiated Thyroid Cancer. Experimental and Clinical Endocrinology & Diabetes: Official Journal, German Society of Endocrinology [and] German Diabetes Association, 126(9), 546–552. https://doi.org/10.1055/s-0043-125064
(13a) [NOTE: News about Dr. Breger’s license suspension — Breger is a controversial case, not like Dr. Matsusaki’s. Symptoms are relevant but we also believe all thyroid hormones should be tested (Free T3 and Free T4), not just TSH, to check SAFE dosages. We support a more scientific and research-based approach to thyroid testing and therapy, as did Dr. Ron Matsusaki.] CBC News. (2015, April 21). Dr. Barry Breger facing sanctions after letting patient decide own dosage. CBC. Retrieved from https://www.cbc.ca/news/canada/montreal/dr-barry-breger-facing-sanctions-after-letting-patient-decide-own-dosage-1.3042577
(13b) [NOTE: Patient testimonies about Dr. Breger. Dr. Breger is currently practicing but under a limited license regarding thyroid therapy. Click on subsequent pages to get historical reports of patients many years back. ] RateMDs. (n.d.). Dr. Barry Breger. Retrieved April 21, 2019, from RateMDs website: https://www.ratemds.com/doctor-ratings/110357/Dr-Barry-Breger-Montreal-QC.html
(14a)[NOTE: This is a list of thyroid doctors who have been punished for their efforts. Dr Derry is from Canada. One of the reasons appears to be territorial battles between doctors over who gets to supervise a patient’s thyroid therapy] https://healthimpactnews.com/2013/when-medically-effective-non-mainstream-doctors-lose-their-licenses/
(14b) [NOTE: This is an interview with Canadian thyroid doctor, Dr. Derry from July 2000, before his license was taken away] Shomon, M. (2000, July). Rethinking the TSH Test: An Interview with David Derry, M.D., Ph.D. The History of Thyroid Testing, Why the TSH Test Needs to Be Abandoned, and the Return to Symptoms-Based Thyroid Diagnosis and Treatment — Articles / FAQs. Retrieved April 21, 2019, from http://www.thyroid-info.com/articles/david-derry.htm
(14c) [NOTE: This is the main page of information about Dr. Derry, from an archive of an old website. ] Breast Iodine Thyroid Effectiveness Society (BITES). (2004, October 11). Dr. David Derry [The doctor, The patients; The College]. Retrieved April 21, 2019, from http://web.archive.org/web/20041011010949/http://www.bites-medical.org/dderry.html
(15) [NOTE: This clinical study engages in the TSH versus T3 debate] Peterson, S. J., McAninch, E. A., & Bianco, A. C. (2016). Is a Normal TSH Synonymous With “Euthyroidism” in Levothyroxine Monotherapy? The Journal of Clinical Endocrinology & Metabolism, 101(12), 4964–4973. https://doi.org/10.1210/jc.2016-2660
(16) Abdalla, S. M., & Bianco, A. C. (2014). Defending plasma T3 is a biological priority. Clinical Endocrinology, 81(5), 633–641. https://doi.org/10.1111/cen.12538
(17) Meier, C., Trittibach, P., Guglielmetti, M., Staub, J.-J., & Müller, B. (2003). Serum thyroid stimulating hormone in assessment of severity of tissue hypothyroidism in patients with overt primary thyroid failure: cross sectional survey. BMJ, 326(7384), 311–312. https://doi.org/10.1136/bmj.326.7384.311
(18) Kishi, T. (2015). Free triiodothyronine, not thyroid stimulating hormone, should be focused on for risk stratification in acute decompensated heart failure. Journal of Cardiology, 66(3), 201–202. https://doi.org/10.1016/j.jjcc.2015.05.001
(19) Lee, Y.-M., Ki, Y.-J., Choi, D.-H., & Kim, B.-B. (2015). Value of Low Triiodothyronine and Subclinical Myocardial Injury for Clinical Outcomes in Chest Pain. The American Journal of the Medical Sciences, 350(5), 393.
(20) Berent, D., Zboralski, K., Orzechowska, A., & Gałecki, P. (2014). Thyroid hormones association with depression severity and clinical outcome in patients with major depressive disorder. Molecular Biology Reports, 41(4), 2419.
(21) Bunevicius, R., & Prange, A. J. (2000). Mental improvement after replacement therapy with thyroxine plus triiodothyronine: relationship to cause of hypothyroidism. The International Journal of Neuropsychopharmacology, 3(2), 167–174.
(22) Ataoğlu, H. E., Ahbab, S., Serez, M. K., Yamak, M., Kayaş, D., Canbaz, E. T., … Yenigün, M. (2018). Prognostic significance of high free T4 and low free T3 levels in non-thyroidal illness syndrome. European Journal of Internal Medicine. https://doi.org/10.1016/j.ejim.2018.07.018
(23) Rhee, C. M., Brent, G. A., Kovesdy, C. P., Soldin, O. P., Nguyen, D., Budoff, M. J., … Kalantar-Zadeh, K. (2015). Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients. Nephrology Dialysis Transplantation, 30(5), 724–737. https://doi.org/10.1093/ndt/gfu024
(24) Bertoli, A., Valentini, A., Cianfarani, M. A., Gasbarra, E., Tarantino, U., & Federici, M. (2017). Low FT3: a possible marker of frailty in the elderly. Clinical Interventions in Aging, 12, 335–341. https://doi.org/10.2147/CIA.S125934
(25) Quinlan, P., Horvath, A., Wallin, A., & Svensson, J. (2019). Low serum concentration of free triiodothyronine (FT3) is associated with increased risk of Alzheimer’s disease. Psychoneuroendocrinology, 99, 112–119. https://doi.org/10.1016/j.psyneuen.2018.09.002
(26) Kaya, H., Ertas, F., & Soydinc, M. S. (2012). Low serum free triiodothyronine levels are associated with the presence and severity of coronary artery disease in the euthyroid patients: an observational study. The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi), 12(7), 591.
(27) Pearce, S. H. S., Razvi, S., Yadegarfar, M. E., Martin-Ruiz, C., Kingston, A., Collerton, J., … Jagger, C. (2016). Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study. The Journal of Clinical Endocrinology and Metabolism, 101(11), 4385–4394. https://doi.org/10.1210/jc.2016-1935
(28) van Vliet, N. A., van der Spoel, E., Beekman, M., Slagboom, P. E., Blauw, G. J., Gussekloo, J., … van Heemst, D. (2017). Thyroid status and mortality in nonagenarians from long-lived families and the general population. Aging (Albany NY), 9(10), 2223–2234. https://doi.org/10.18632/aging.101310
(29) ERFA Canada 2012. (n.d.). Thyroid® – ERFA Canada 2012 Inc. Retrieved April 21, 2019, from http://eci2012.net/product/thyroid/
(30) [NOTE: Discusses thyroid prescribing trends including T3-T4 combination therapy and desiccated thyroid ] Jonklaas, J., Tefera, E., & Shara, N. (2019). Short-Term Time Trends in Prescribing Therapy for Hypothyroidism: Results of a Survey of American Thyroid Association Members. Frontiers in Endocrinology, 10. https://doi.org/10.3389/fendo.2019.00031
(31) Sweet, L. (2007, January). Envy – Seven Deadly Sins | Medical Board of California. Retrieved April 27, 2019, from http://www.mbc.ca.gov/Licensees/Seven_Deadly_Sins/Envy.aspx
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