1. TESTING AND MONITORING
We call on Canadian medical associations and government health departments to put an end to the over-reliance on the TSH test and the broad statistical reference range as the primary indicators of our thyroid health and life-long therapy.
Like other Canadians, we deserve the freedom to live full and productive lives with optimal thyroid balance, not just hormone levels that fall anywhere within the “normal” range.
We call on our doctors to cooperate with us in adjusting our hormone therapy until it removes as many clinical signs and symptoms of hypothyroidism as possible, without causing signs and symptoms of hyperthyroidism.
It is not acceptable to allow us to languish for months, years or decades with suboptimal thyroid hormone levels of T3 and T4, especially a low T3:T4 ratio, which can hide under a “normal” TSH.
Canadian autoimmune thyroid patients deserve a more complete diagnosis of their thyroid gland health and antibody types and levels, including TSH-receptor blocking antibodies, which are known to cause gland atrophy and variable TSH levels.
2. TREATMENT OPTIONS
Canadian thyroid patients and their doctors deserve access to the full range of synthetic and animal-derived thyroid hormone products that have been successfully used in therapy since the 1800s and have long ago been approved by Health Canada.
Patients who are not responding ideally to the standard synthetic L-T4 therapy (Synthroid, Levothyroxine, or Eltroxin) must be permitted to explore other therapies that include the T3 hormone.
Doctors should understand how oral dosing of T3-based therapies affects TSH, T3 and T4 levels in blood so that all forms of thyroid hormone therapy can achieve their best result.
Canada must maintain market supply and affordable pricing of all thyroid hormone pharmaceuticals.
Future thyroid research must include T3 hormone measurements, not just the TSH, and not just TSH and T4 alone, and should continue to investigate the molecular action of thyroid hormone metabolites and the responses of hormone receptors.
We need to understand the effects of subtle shifts in thyroid hormone relationships even within the statistical normal range not only during health and in untreated disease, but also under the artificial conditions of various hormone therapies.
Whenever possible, research on thyroid patients should include antibody types and levels, clinical signs and symptoms, and other relevant indicators such as ultrasound data in order to understand more of the variables that could interrelate.
Thyroid patients taking hormones must be included in future research on disorders involving derangements in thyroid hormones, especially the misnamed phenomenon of “non-thyroidal illness” (low-T3 syndrome).
4. PROFESSIONAL AND PUBLIC EDUCATION
Canadian citizens must become more aware of the burdens of undiagnosed or poorly treated hypothyroidism on individual health, our families, communities, and economy.
We must not isolate hypothyroidism as a disease but see it in context with its direct and powerful influence on other major diseases such as heart disease, osteoporosis, adrenal insufficiency, obesity, and psychological disorders.
Our doctors should have professional freedom to order all relevant tests and the education to interpret them in light of our symptoms and clinical signs. We expect our doctors to partner with us in fine-tuning our therapy to eliminate symptoms. We deserve to be treated with respect for our growing expertise and knowledge of our own condition.
We call on the Canadian College of Endocrinology and Metabolism to designate researchers and experts in hypothyroidism in every province and territory. These experts would actively investigate the complexity and variety of patient response to various treatments and would advise their peers as well as general practitioners.
- We would like to see endocrinology integrate knowledge of thyroid autoimmunity and hypothyroid therapy with its understanding of other serious, lifelong metabolic disorders.
- The college must develop more detailed and broad guidelines for the testing and treatment of hypothyroidism that go far beyond synthetic L-T4 and the TSH test. Our condition ought to be treated with the same diligence and attention to detail as diabetes.
- Guidelines should not be rigidly applied to all individual cases; each endocrinologist must have the freedom to employ professional discernment and critical thought.
Next section: Challenges: Testing, part 1
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