Sticking Out Our Necks: Thyroid Disease News Report, From Mary Shomon / Email Edition -- Jan/Feb 2003

Notes From Mary: A Tribute To Pat Shomon

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Welcome to the sixty-fifth issue of "Sticking Out Our Necks!" my thyroid disease news report. This newsletter is copyrighted by Mary Shomon, and cannot be legally reproduced without permission. Feel free, however, to forward a single copy to someone who might be interested in reading the newsletter or subscribing to it in the future.

ON THE WEB: My Thyroid Disease Information Source and News Report home page is located at http://www.thyroid-info.com, and I also run a comprehensive Thyroid Disease site at About.com, which you can visit at http://thyroid.about.com.

SEND NEWS! If you see something thyroid-related in the news or on the web, please feel free to let me know, send me a note, or forward the URL to me if it's on the web. My email is news@thyroid-info.com, regular mail is P.O. Box 0385, Palm Harbor, FL 34682, fax is: 425-977-1175

ENDOCRINOLOGISTS SAY TSH NORMAL RANGE IS NOW 0.3 TO 3
MILLIONS MORE HAVE THYROID PROBLEMS UNDER NEW GUIDELINES

According to the American Association of Clinical Endocrinologists (AACE), 1 in 10 Americans - more than the number of Americans with diabetes and cancer combined - suffer from thyroid disease, yet as many as half remain undiagnosed. In order to counteract this lack of awareness and educate the public about the prevalence of thyroid disease, diagnosis, and treatment, in January, AACE continued its annual thyroid awareness campaign. The 2003 campaign, Hiding in Plain Sight: Thyroid Undercover, launched as part of the January 2003 Thyroid Awareness Month.

According to the AACE, until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range. The new guidelines narrow the range for acceptable thyroid function, and AACE is now encouraging doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.04. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now. AACE estimates that the new guidelines double the number of people who have abnormal thyroid function, bringing the total to 27 million.

AACE made the decision to narrow the range because of data suggesting many people may have low-level thyroid problems that could be improved with treatment and a narrower TSH range will give doctors reason to more carefully consider those patients.

"The prevalence of undiagnosed thyroid disease in the United States is shockingly high - particularly since it is a condition that is easy to diagnose and treat," said Hossein Gharib, MD, FACE, and president of AACE. "The new TSH range from the AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it can lead to more serious effects on a patient's health - such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression."

COMMENTARY FROM MARY

While it is a dramatic improvement in the awareness of endocrinologists that they are now realizing that the high end of the normal range was not, in fact, normal for most of the population, it's clear they still have a way to go when you read the words of Dr. Gharib, an endocrinologist and president of AACE. Dr. Gharib parrots the official endocrinologist party line when he states that thyroid disease, "is a condition that is easy to diagnose and treat."

This pronouncement contradicts Dr. Gharib's own statement. Until November of 2002, people who had clear symptoms of thyroid disease, but were in the .1 to .3, or 3 to 6 range on the TSH scale, were considered "euthyroid" or normal by almost all endocrinologists and practitioners, and were NOT diagnosed at all, much less easily diagnosed. People who had family histories of thyroid disease, symptoms (including enlarged thyroid, goiter, nodules, etc.) but whose TSH tests were in the low or high end of normal who were testing in these levels were routinely denied treatment, or told that their problems were the result of depression and given antidepressants. This has gone on for decades, as conventional medicine has relied on the TSH test -- often to the exclusion of clinical evidence, symptoms and medical observation -- to make a diagnosis. I would not consider this evidence of "easy to diagnose" -- particularly from the perspective of the millions of patients who have suffered with undiagnosed thyroid disease, not to mention the suffering that resulted from being misdiagnosed with a host of mental or physical ailments by their doctors, and prescribed various drugs, hormones, and other inappropriate treatments.

As for the "easy to treat" component, a survey I just conducted, reported on in this issue, found that more than 50% of respondents reported that they are not satisfied with their thyroid treatment. A Thyroid Foundation of America survey found that more than two-thirds of Graves' disease patients continued to suffer debilitating symptoms after treatment and while "euthyroid." A study published in the February, 2002 issue of the Journal of Clinical Endocrinology and Metabolism found that nearly five percent of Americans suffer from often undiagnosed thyroid disease. And those projections were based on the earlier .5 to 5-6 TSH "normal range." If thyroid disease is so easy to diagnose, why are millions of people undiagnosed?

Perhaps more telling were the results of the groundbreaking Colorado Thyroid Prevalence Study, reported on in the February 2000 issue of the Archives of Internal Medicine, the study found that among patients taking thyroid medication, only 60% were within the normal range of TSH (and again, that was according to the .1 to 5-6 TSH range). The fact that forty percent of patients, a number that translates to millions of Americans, are already taking thyroid hormone and being treated by a doctor but are still not in TSH range indicates that proper treatment is not as easy as Dr. Gharib suggests.

The inadequacy of treatment's ability to relieve symptoms was also addressed in February of 1999 when the February 11, 1999 New England Journal of Medicine published a landmark T3 thyroid drug study that found that the majority of patients studied felt better on a combination of two drugs, including levothyroxine (T4) and T3, and NOT solely levothyroxine/T4 (i.e., Synthroid, Unithroid, or Levoxyl) alone. Levothyroxine alone is the standard treatment.

The AACE has finally moved into the 21st century in terms of its awareness that the outdated TSH reference range needed revisiting, but it's just a first step among many much-needed revisions to the diagnosis and treatment of thyroid disease.

(Source: Canaris, et. al. Vol. 160 No. 4, February 28, 2000, "The Colorado Thyroid Disease Prevalence Study," Archives of Internal Medicine.)

2003 THYROID SURVEY RESULTS -- SUMMARY FIRST PATIENT QUALITY-OF-LIFE SURVEY OF NEARLY 1000 PATIENTS PUBLISHED

From late 2001 to 2002, a survey was conducted with readers of my various thyroid disease websites. Final results will be published later in 2003, but preliminary results, based on a tally of 907 respondents, are being published now, to bring increased visibility to thyroid issues.

This is the first large-scale quality of life survey of thyroid patients, and the first to look at critical patient concerns such as unrelieved symptoms, weight problems, attitudes toward patient organizations, smoking behavior, and effective treatments and solutions.

There are some very surprising and interesting findings from the survey, everything from symptoms you may not realize that are related to your thyroid, to weight loss solutions that patients themselves have found helpful, to what thyroid patients REALLY think about the various patient organizations. Read a summary of the findings, or see the detailed numbers online now, at:

Survey Findings Summary
Detailed Survey Findings

HYSTERECTOMY INCREASES RISK OF THYROID CANCER

The risk of thyroid cancer is doubled during the first two years post-surgery in women who have a hysterectomy.

Source: Luoto R, et. Al. "Increased risk of thyroid cancer among women with hysterectomies," Am J Obstet Gynecol 2003 Jan;188(1):45-8)

MORE HEART DISEASE RISK FACTORS FOUND FOR HYPOTHYROIDISM

Researchers have found that hypothyroidism is typically accompanied by elevated elevated C-reactive protein and total homocysteine levels. Elevations in C-reactive protein and total homocysteine have been identified as risk factors for developing coronary heart disease. Levothyroxine replacement did not significantly affect either total homocysteine or C-reactive protein levels. (Source: Christ-Crain M, et. al. "Elevated C-reactive protein and homocysteine values: cardiovascular risk factors in hypothyroidism? A cross-sectional and a double-blind, placebo-controlled trial," Atherosclerosis, February 2003;166:2:379-386.)

THYROID DISEASE FREQUENTLY GOES UNDIAGNOSED IN CANCER PATIENTS

Researchers have found that thyroid dysfunction is usually unrecognized in cancer patients and may possibly contribute to their symptoms and recovery. (Source: Shani, Dana et. al. "Unrecognized thyroid dysfunction in patients with cancer," Supportive Care in Cancer)

THYROID FUNCTION AND PREGNANCY

Researchers looked at thyroid function during pregnancy. According to the researchers, there is growing evidence that suggests a strong association between the presence of thyroid antibodies and miscarriage or fetal loss. Hypothyroidism during pregnancy, but without symptoms, appears to occur in as many as 2.5% of women. Since undetected and untreated hypothyroidism can negative affect the IQ of the child, the researchers suggest that regular screening for hypothyroidism in early pregnancy may be justified. Postpartum thyroid disease occurs in as many as 5 to 9% of women in general, and 50% of women who are thyroid peroxidase antibody positive (TPO Ab+ve). Among those who have transient postpartum thyroid function, a significant percentage do develop hypothyroidism. (Source: Lazarus JH., "Thyroid dysfunction: reproduction and postpartum thyroiditis," Semin Reprod Med 2002 Nov;20(4):381-8)

FILM CRITIC EBERT RECUPERATING FROM THYROID CANCER SURGERY

Film critic Roger Ebert is recuperating from follow-up surgery for papillary cancer. A year ago, doctors removed Ebert's thyroid gland and selected lymph nodes in his neck. (Wire services)

INSIDE MARY SHOMON'S MEDICINE CABINET
Find out what thyroid medicine I take, as well as my daily supplements and vitamins, what I take to fight colds and flus, things that help with weight loss, enhance energy, and help hair and skin.

CANADIAN BABY BOOMERS POPPING PILLS -- ESP. SYNTHROID -- AT RECORD RATE

Canada's baby boomers are popping prescription pills at a record pace. Retail spending on prescription medications climbed by 8.1 per cent, and is running an estimated $187 for every man, woman and child in the country, or an overall $15.5 billion annually. The thyroid drug Synthroid was the top-selling drug in Canada in 2002 and in 2001, and more than seven million prescriptions were filled last year. The U.S. is seeing an even greater increase in prescription drug sales, with overall spending of $154.5 billion U.S. on drugs at retail outlets in 2001. (Source: The Ottawa Citizen, February 1, 2003)

TWO COMPANIES RECEIVE FDA APPROVAL TO SELL POTASSIUM IODIDE PILLS

With Internet sales of potassium iodine products brisk since the September 11th terrorist attacks, two companies have now received Food and Drug Administration approval to sell potassium iodide pills at U.S. retail outlets. One company is Anbex of New York, which received approval for its product, Iosat. Anbex has been making Iosat since 1982. The other company is RECIP US, a U.S. division of Swedish company RECIP AB, which makes ThyroSafe, and has been selling potassium iodide in Europe for years. Potassium iodide, when taken fairly quickly in the timeframe after exposure to radioactive iodine I-131 (such as after a nuclear accident), can prevent thyroid cancer by flooding the thyroid gland with a harmless form of iodine, and preventing the thyroid from absorbing the radioactive iodine. The products are expected to be available in food and drug stores this spring. Of potassium iodine, Anbex spokesperson Jo Flattery has said, "It's no longer this obscure survivalist drug. It's gone mainstream."

Iherb.com sells several potassium iodide products, including:

Source Naturals Potassium Iodide
NoRad Potassium Iodide
and when they have it in stock, the Anbex Iosat

You can also order from Iherb by phone, at 1-888-792-0028 (1-626-358-5678)

PERCHLORATE IN THE NEWS

The rocket fuel/explosives manufacturing by-product, perchlorate, which is a chemical that is known to disrupt thyroid function and cause other health problems, is increasingly the focus of public, media and government attention. This is in large part due to the efforts of activists like Larry Ladd, who for years has been tirelessly working to raise visibility and awareness of the perchlorate issue. For a detailed list of the latest news stories on perchlorate, do a Google news search

You can visit Larry Ladd's site at http://www.perchlorate.org

And check out some of the coverage of the perchlorate/thyroid issue featured at my site since 1999:

1/1/03 -- Perchlorate in the News
Eating lettuce or other veggies may expose some consumers to high levels of the thyroid-toxic rocket fuel perchlorate. Perchlorate is increasingly in the news this year, and knowing more about this toxin may help protect you and your family.

6/20/02 -- Aberdeen, MD Well Closed After Thyroid-Damaging Chemical Found
Aberdeen, MD has closed one of its drinking water wells after the chemical perchlorate -- which can damage the thyroid -- was found.

1/24/02 -- Perchlorate in Your Water -- How Little is Little Enough?
As time goes by and perchlorate remains in the water supply, what exactly is the danger point at which perchlorate in the water supply endangers the thyroid? The Las Vegas Review Journal takes a look.

8/9/01 -- Thyroid Toxin Endangers Water for Millions in Calif. & US
Perchlorate contamination and its danger to Californians and Americans and their health -- including thyroid cancer danger -- is detailed in a new report from the Environmental Working Group, titled "Rocket Science: Perchlorate and the Toxic Legacy of the Cold War."

11/27/00 -- Volunteers to Ingest Perchlorate, Potentially Thyroid-Damaging Pollutant, in Water Safety Study
Ethical questions, conflict of interest suggestions, and health concerns are being raised by a new study in which participants are being paid to ingest a chemical that is harmful to the thyroid.

8/21/00 -- Chemical in Drinking Water May Create Thyroid Problems
Researchers find that perchlorate in drinking water may be creating thyroid problems in Arizona newborns.

8/31/99 -- Perchlorate Found in U.S. Fertilizers: Chemical Acts as Antithyroid Agent
Review of the news that shows the thyroid-damaging chemical perchlorate present in U.S. fertilizers and what this means for our food and water supply.

6/19/99 -- Thyroid Perils of Our Water & Food
Why won't the Air Force release information to EPA on perchlorate, a chemical in our food and water that can harm the thyroid?

TSH: CAN IT MEASURE THYROID STATUS?

In a somewhat confusing editorial in the February issue of the British Medical Journal, controversial endocrinologist Anthony Toft says that measurement of serum TSH alone may not always reflect thyroid status.

According to Toft, "some patients seeking an explanation for feeling 'below par' are disappointed when thyroid function tests are normal. Unable to accept that there may be psychosocial reasons for their symptoms, a vociferous minority believe that hypothyroidism may exist with normal serum concentrations of both thyroxine (T4) and thyroid stimulating hormone (TSH). Their hypothesis is that a doctor cannot know whether a concentration of free T4 or TSH within wide reference ranges is normal for that individual."

Dr. Toft goes on to dismiss that argument, claiming that patients and their "misguided medical practitioners" don't understand the sensitivity of the TSH process. Toft also says that "raised or undetectable serum TSH...is not usually associated with symptoms, hence the basis for the unsatisfactory terms subclinical hypothyroidism and hyperthyroidism."

But then, Toft appears to switch gears, and states that "It is not sufficient to satisfy the recommendations of the American Thyroid Association by simply restoring both serum T4 and TSH concentrations to normal, as in our experience most patients feel well only with a dose resulting in a high normal free T4 and low normal TSH concentration, and those patients with continuing symptoms despite 'adequate' doses of thyroxine may be slightly under-replaced."

An interesting read, worth checking out, the full online version is available at: http://bmj.com/cgi/content/full/326/7384/295

TSH IS INADEQUATE FOR MEASURING SEVERITY OF HYPOTHYROIDISM

Reporting in the February 2003 issue of the British Medical Journal, Swiss researchers have reported that there is a broad spectrum in terms of symptoms that are not necessarily correlated to the level of hypothyroidism. Patients who are significantly hypothyroid in terms of their test results may have minimal symptoms, while those with only mild elevations may have substantial symptoms. Since TSH is supposed to correspond to the severity of hypothyroidism, the researchers' objective was to determine how valuable TSH is in measuring the severity of tissue hypothyroidism.

A total of 49 people who had overt hypothyroidism, and TSH levels greater than 20 were studied. Those with low Free T4 and Low T3 levels showed evidence of tissue hypothyroidism, including slowed reflexes, elevated cholesterol, compared to those with the same TSH levels and less aberrant Free T4 and T3 levels. This led the researchers to conclude that "TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure. This is in sharp contrast to the high diagnostic accuracy of TSH measurement for early diagnosis of hypothyroidism...

The abstract concludes "...secretion of TSH is driven by maximal stimulation, with no further increase occurring with greater severity of hypothyroidism. Therefore, the biological effects of thyroid hormones at the peripheral tissues--and not TSH concentrations--reflect the clinical severity of hypothyroidism. A judicious initiation of thyroxine treatment should be guided by clinical and metabolic presentation and thyroid hormone concentrations (free thyroxine) and not by serum TSH concentrations."

Read the full abstract at the British Medical Journal site, http://bmj.com/cgi/content/full/326/7384/311

Source: Meier, et. al., "Serum thyroid stimulating hormone in assessment of severity of tissue hypothyroidism in patients with overt primary thyroid failure: cross sectional survey," British Medical Journal, 2003;326:311-312 ( 8 February), http://bmj.com/cgi/content/full/326/7384/311

RELAPSES IN GRAVES' DISEASE

Norwegian researchers looked at the effects of different antithyroid drug (ATD) regimens on relapse rates of Graves' disease and reported their findings in the European Journal of Endocrinology. The study looked at groups of Graves' disease who either took an ATD with levothyroxine (a regimen sometimes called "block-replace therapy), or an ATD alone for 12 months. After stopping ATD therapy, each group either had 12 months of subsequent levothyroxine treatment, or no treatment. The patients were evaluated before treatment, at 3 weeks, 6 weeks, and every 3 months for a year. Those who didn't relapse were also evaluated every three months for another year, and then annually thereafter. The researchers found that in general, the proportion of relapse among all groups didn't vary, and was 47.7% two years after withdrawal of ATD. Smokers had a higher relapse rate than non-smokers (58.4% vs 38.8%) and those who were positive for thyrotropin-receptor antibodies (TRAb) 12 months after antithyroid therapy also had a higher relapse rate (72.5% vs 36.8%), and those with large goiter had higher relapse rates (55.5% vs 36.3%). So, while the type of ATD and levothyroxine therapies were not related to relapse rates, smoking, large goiter, and presence of antibodies after ATD therapy were predictive of relapse.

Source: Nedrebø1, et. al., "Predictors of outcome and comparison of different drug regimens for the prevention of relapse in patients with Graves' disease," European Journal of Endocrinology, Vol. 147 Part 5

LATEST AT THE THYROID SITE

I'M A NEW ME
If having a thyroid problem makes you grouchy, Jody LaFerriere will help change your attitude with her light-hearted list of positive things to think about.
http://thyroid.about.com/library/weekly/aanewme.htm

THE 10 THINGS YOUR DOCTOR MAY NOT HAVE TOLD YOU ABOUT GRAVES' DISEASE
Expert and author Elaine Moore shares important information about Graves' disease and hyperthyroidism that you need to know. http://thyroid.about.com/library/weekly/aa10things.htm

THOUGHTS AND FEELINGS: HOW THEY CAN CAUSE THYROID PROBLEMS
Dr. Brian Sheen, a best selling author and Director of The Quantum Healing Center in Delray Beach, Florida, explores his theories regarding how the accumulation of unexpressed thoughts and feelings can cause low thyroid. Read this fascinating spiritual therapy-based approach toward thyroid treatment.
http://thyroid.about.com/library/weekly/aasheen.htm

THE MOST IMPORTANT STEPS IN LOSING WEIGHT AND TONING UP

By Shawn C. LeBrun, Certified Personal Trainer

Here are some of the most important steps in losing fat weight, toning up, and just plain old feeling better!

1. Set a goal for yourself and get real about achieving it.

Until you set a goal of how much weight you want to lose, you are just dreaming. Dreams do not happen unless you commit to them happening.

In fact, a goal is a wish with a deadline. It needs to be specific and written down. If losing body fat is what you want to do, you must be willing to pay a certain price to achieve it.

So, set goals and get real about achieving them. Before any other step, this is the most important one. If you are not real and serious about losing fat, all the other steps will not help you.

2. Drink your life away! (well, not really)

If you have ever doubted the importance of water, try going a few days without it. You can live weeks without food, but only days without water. It is used in EVERY single physiological process your body undergoes.

Its importance cannot be stated enough, especially when it comes to fat-loss and fitness training. Shoot for at least a gallon a day, preferably more. The inconvenience of constantly using the bathroom is a minor drawback compared to the benefits you will receive.

Keep a bottle wherever you spend most of your day, at your desk at work, in your car, hell, wear a water bottle around your neck, but just get enough water.

3. Eat 5-6 (or more) small meals a day consisting of high protein, moderate carbs, and low-fat.

This is important in keeping your metabolism efficiently burning calories. Constantly grazing on meals every 3 hours will allow your body to burn off what it has consumed quicker and more efficiently.

Eating one or two larger meals will actually cause your body's metabolism to slow down.

Skipping meals altogether will actually cause your body to store fat as a defense mechanism. Your body is not sure when its going to get its next meal so it tends to store more in case of perceived famine.

Make each meal consist of higher protein (builds muscle), moderate carbohydrates (fuel for the body) and low fat (energy and protection).

4. Do INTENSE cardiovascular workouts 3-4 times a week.

This is where the majority of the calorie burning takes place. Not necessarily from the cardio you just did, but from the fact that doing cardio increases your metabolic rate so that the rest of the day you will burn off more calories as well. Put all of your energy and intensity into your cardio. Do 20-30 minutes of cardio 3-4 days a week. During a session of cardio, warm- up for 5 minutes, then do 20 minutes at a high intensity pace. Then cool down for the last 5 minutes. Go at a fast enough pace where you are sweating, panting, huffing, puffing, turning red. Get your body out of homeostasis (everything's normal and in balance).

Doing cardio for the sakes of doing it will not burn fat. Going for a leisurely walk will not sufficiently burn fat, unless you walk ten miles. Riding a stationary bike while relaxingly reading the paper will not burn much fat.

Hey, its only 30 minutes. Bust your butt for this time and the return on your investment will be great. Choose cardio machines that get more of your body moving. The more you move, the more you burn.

5. Do INTENSE Weight training at least 3-4 times a week.

Do not mistake weight training w/ trying to burn fat. Weight training will not burn a sufficient amount of body fat. What weight training will do is help you burn fat in the future. When you add muscle to your frame, your body has to expend more energy (burn more calories) to maintain that muscle tissue.

So when you are at rest, even sleeping, the more lean muscle mass you have, the more calories you will expend. Weight training will not only strengthen existing muscle, but will add additional lean muscle tissue to handle any future demands placed on the muscle. The more lean muscle tissue you have, the more calories you will expend at rest. Not bad, huh?

6. Figure out your daily energy expenditure and reduce it.

Most people do not like to calorie count, me included. But in order to properly lose body fat, you need to determine your daily energy expenditure or caloric maintenance level. You then need to reduce your energy consumption to be below your energy output. It's difficult to place a number on how much below your consumption you should go, because everyone is different. A good place to start would be 150-200 calories below your maintenance levels. Then continue to observe the effects in the mirror to determine if this number needs to be changed. If you continue to see no results, try reducing your energy consumption to 300 calories below your energy output.

7. Continue to up your weight (overload) when doing resistance training.

Remember that building lean muscle will assist you in the fat-burning process later on. The more muscle you have, the more energy your body expends to maintain that muscle, even at rest. In order to make constant and significant gains, remember to train intensely and for short durations. I like to call them "bursts of exercise!" Try and work no more than 2 muscle groups a workout, 3 workouts a week. Keep reps lower than higher. This will cause you to maintain high enough resistance to add overload to the muscle, causing more muscle growth. Do only 2-3 heavy sets per exercise and keep workouts no longer than 45 minutes. Keep your workouts intense and to the point. Do it and get out of the gym. DO NOT DO YOUR CARDIO BEFORE WEIGHT TRAINING! It's hard to focus intensely on both weight training and cardio in the same session. Do not rob one to pay the other.

These are 7 simple (well, not so simple if you do them well!) ways you can maximize fat burning while increasing the likelihood of not losing much muscle.

Visit Shawn LeBrun Fitness for highly effective, low cost solutions for weight loss and toning. Get your fitness tips straight from the trainer's mouth! http://www.shawnlebrunfitness.com

THREE STEPS TO HAPPINESS! HEALING THROUGH JOY

If you need to stop, reconnect with the people and things that bring you joy and happiness in this life, a simple book by one of my favorite doctors, Jacob Teitelbaum, MD, is required reading. I've been carrying this book around for a month, reading it when I need inspiration and uplifting, and finding it to be a total treasure.

Dr. Teitelbaum, a doctor who specializes in chronic fatigue, fibromyalgia, and thyroid problems, and who himself suffers from chronic fatigue syndrome, has outlined in a simple, easy-to-read way a three-step process that will help you move into your natural, joyful state of being.

Says Dr. Teitelbaum: "Happiness is our natural state of being. It is who we are. This happiness is obvious when you look at little children before they take society's beliefs. Their natural state is to feel all of their feelings without resistance, leaving them free to spend most of their time being happy and playful. It is not necessary to be happy all the time. By applying the simple three-step principles in this book, however, you can develop the ability to be happy whenever you choose."

Dr. Teitelbaum's personal experience with thousands of very ill patients shows that these techniques can help you reclaim both health and passion in your life!

You can get the book at bookstores, online from Amazon.com. by ordering directly from Dr. Teitelbaum online or by calling Dr. Teitelbaum's office at 410-573-5389.

TOP TEN THINGS TO DO FOR YOURSELF THIS YEAR

By Sibyl McLendon

1. Learn to love yourself. You are just as deserving of your love and respect as anyone else is. When you learn to love yourself, you treat yourself better because you know that you are worthy of it.

2. Realize that you deserve only the best that life has to offer. When you know that you deserve the best, you'll go out and create the best for yourself.

3. Set a goal for yourself and then do what you need to do to reach it. No matter how small the goal, reaching it will make you feel very good about yourself.

4. Learn a new skill. Learning is how we grow and assure ourselves that we are alive and capable.

5. Take time just for yourself every day. Even 15 minutes a day is enough to re-charge your battery. This is not selfish; it is self- preservation.

6. Do something creative. Find a hobby that you enjoy and just do it. Creativity just feels good.

7. Tell the people that you care about how you feel. Never pass up the chance to tell someone that you love him or her. This way, you will never feel the pain of regret.

8. Let go of the past. It is gone forever. Learning to live in the here and now is invaluable in making every day the best.

9. Let go of one grievance or prejudice. We all have them, and they are just black holes on our soul.

10. Laugh every single day. One good belly laugh is healing. If see anything to laugh at, you aren't looking hard enough.

Sibyl McLendon is 1/2 Navajo, and is a personal empowerment coach for Circle Of Grace http://www.circle-of-grace.com, Sibyl can be contacted at sibyl@www.circle-of-grace.com

FIVE STEPS TO PREVENTING MEDICATION ERRORS

Medication errors occur every day, both in the health care setting and at home. Although no medicine is entirely risk-free, you can take precautions to ensure your safety.

In the hospital, medicines pass through a series of steps to prevent possible errors before reaching the patient. This helps protect the safety of patients during their hospital stay.

"Checks are in place at the point when medicine is prescribed, when the prescription order is documented, when the medication is dispensed, and when the prescribed medicine is administered to the patient," says Diane Cousins, R.Ph., vice president of the Center for the Advancement of Patient Safety at the United States Pharmacopeia (USP). "The patient is also monitored to assess any response to the medication-all in an effort to ensure patient safety."

In the home, consumers must make informed decisions on their own about the safe use of medicines. A free brochure, "Think It Through: A Guide to Managing the Benefits and Risks of Medicines," is now available to help consumers safely use medications. This free brochure is available on the Web at: www.usp.org/thinkitthrough.

This brochure educates consumers on the five critical steps in making decisions about medications: Talk, Know, Read, Avoid, Monitor. These steps allow consumers to lower the risks and obtain the full benefit from medications.

Talk with your doctor, pharmacist, or other health care professionals. Keep an up-to-date list of medicines and dietary supplements you use, and always ask questions about any concerns or thoughts you may have.
Know your medicines-prescription and over-the-counter. Be aware of when, how, and how long to use them, what to do if you miss a dose, and whether or not there are any side effects.
Read the label and follow directions. Always double-check that you have the right medicine, particularly if you are refilling a prescription, and never combine medicines in the same bottle. Make sure you understand the directions; ask if you have questions or concerns.
Avoid interactions. Before starting any new medicine or dietary supplement, ask if there are possible interactions with what you are currently using. Whenever possible, use the same pharmacy for all your medication needs.
Monitor your medicines' effects and the effects of other medications or supplements you use. Pay attention to how you are feeling and write down the changes so that you can remember to tell your doctor or pharmacist.

For a free copy of the Think it Through brochure by mail, contact the Federal Citizen Information Center (FCIC) by writing to FCIC, Department 73, Pueblo, CO 81009; by calling (888) 878-3256 and asking for Department 73; or visiting http://www.pueblo.gsa.gov/rc/usp.htm. For more information about USP, visit http://www.usp.org.

DEPRESSION: WHAT EVERYONE SHOULD KNOW

Everyone experiences periods of feeling sad, lonely, or unhappy. When such feelings linger for weeks or months or interfere with your ability to function, you may be suffering from depression. Depression affects 1 9 million Americans-and though it can occur in both men and women, some forms appear to be twice as likely in women.

The specific causes of depression remain unclear. Many factors are suspected to play a role in developing depression. Research is focused on understanding these factors, including reproductive, hormonal, genetic or other biological factors; abuse and oppression; interpersonal factors; and certain psychological and personality characteristics.

"What is clear is that regardless of the contributing factors, depression is a highly treatable illness," said pharmacist Sarah Matunis, R.Ph. "As with any illness, the earlier treatment begins, the more effective and the greater the likelihood of preventing serious recurrences. The first step should be a thorough examination to rule out physical illnesses that may cause depressive symptoms."

Medical problems, such as thyroid disease, can cause depression, which is why a physical examination and medical workup should be conducted before a diagnosis can be confirmed.

"Approximately 10 to 15 percent of those diagnosed with depression may have a thyroid hormone deficiency. Patients with depression should be tested to determine if they have thyroid disorder," added Matunis.

The most common treatments for depression are antidepressant medications, psychotherapy, or a combination of the two.

There are several types of antidepressant medications used to treat depressive disorder. These include newer medications-mainly the selective serotonin reuptake inhibitors (SSRIs), tricyclics (TCAs) and monoamine oxidase inhibitors (MAOIs). Each acts on different chemical pathways of the human brain related to moods. SSRIs such as Prozac®, Zoloft®, Paxil® and Luvox® have fewer side effects and have been found to be particularly useful and effective.

"Although some individuals notice improvement in the first couple of weeks, usually antidepressant medications must be taken for four weeks and, in some cases up to eight weeks, before the full therapeutic effect occurs," said Matunis. "To be effective and to prevent a relapse of depression, medications should be taken for about six to 12 months, carefully following a doctor's instructions. Medication must be monitored to ensure the most effective dosage and to minimize side effects."

Source: NAPSI

MARY SHOMON'S "THYROID DIET SUCCESS GUIDE" -- NEWLY REVISED FOR 2003!

Thousands of people have already ordered their copies of the "Thyroid Diet Success Guide," and people are reporting that the low-glycemic approach featured in the guide is helping them slowly and safely lose weight. And now, I've just updated the guide for 2003!!

Just a few of the key features in the newly updated and revised 35-page Guide include:

Is Your Thyroid Causing Your Weight Problem
Weight Loss Requirement: Optimizing Your Thyroid
Common Questions About Thyroid and Weight Loss
Do Your Doctor's Mistakes Stop You From Losing Weight
The Habits of Successful Weight Loss
Menstrual Cycle Linked to Weight Loss

Weight Loss Secrets for Thyroid Patients
The Thyroid/Weight Loss Connection - Some Theories
How To Lose Weight With Hypothyroidism
Stevia for Sweetening
Nuts for Nuts: Can They Help your Diet?
Weight Loss Success: How I Lost 25 Pounds in 12 Weeks
Choosing a Good Protein Bar
How Much Weight Do You Need to Lose?
The Ultimate Thyroid Exercise Program
Seeing Results with Weight Loss and Exercising
Conjugated Linoleic Acid (CLA) Overview

The Thyroid Diet Success Guide features a diet plan that you can follow, and specific information on exercises, and many other tips and resources. For me, it's been the only way I can effectively lose weight (and believe, me, I've tried them all!!) The Thyroid Diet Success Guide features information about why it's harder for thyroid patients to lose weight, insulin resistance, the role of the adrenal system, and lots of practical suggestions to help you finally enjoy weight loss success. The Thyroid Diet Success Guide will help you get on the right track, with information that has actually helped other thyroid patients -- including me -- to effectively lose weight!

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Buy Your Thyroid Diet Guide Online Now

Order by Mail
To order, U.S. residents can send a check for $15 (which includes shipping and handling) made out to "Sticking Out Our Necks" to:

Mary Shomon's "Thyroid Diet Success Guide"
P.O. Box 0385
Palm Harbor, FL 34682

For an order form to pay by check or credit card, visit http://www.thyroid-info.com/dietbook.htm

Phone Orders
Or call our toll-free order line during weekday business hours at 888-810-9471 to order using your credit card.

SPECIAL OFFER: We have reprinted the "Mini-Guides,” so if you order the "Thyroid Diet Success Guide" you will receive a free pocket-sized "Mini-Guide" that summarizes the key diet tips in a portable, easy-to-carry format!

BOOK RECAP

For the people in your life who have thyroid disease, or who have a suspected thyroid condition, there's my book, Living Well With Hypothyroidism: What Your Doctors Don't Tell You...That You Need to Know. Most people, whether they are hyperthyroid, have autoimmune Graves’ or Hashimoto’s disease, thyroid cancer, nodules or hypothyroidism -- end up being hypothyroid. That's where this book, published in 2000 by HarperCollins, comes in.

If you, a friend, or family member has confirmed or suspected thyroid disease, there's my book, Living Well With Hypothyroidism: What Your Doctors Don't Tell You...That You Need to Know. Most people, whether they are hyperthyroid, have autoimmune Graves' or Hashimoto's disease, thyroid cancer, nodules or hypothyroidism -- end up being hypothyroid. That's where this book, published in 2000 by HarperCollins, comes in. "Living Well With Hypothyroidism" is a top 40 Amazon.com health bestseller, and in October, went to its 16th printing! You can find out more information, read a free chapter online, and get more information on the book and how to order it at http://www.thyroid-info.com/book.htm.

Don't forget that you can order it from Iherb.com for a special rate of $10 by going to Iherb.com's online store.

You can also order Living Well With Hypothyroidism from Amazon.com for $11.20 plus shipping, by clicking here.

For the people in your life who have a diagnosed autoimmune disease, or who have symptoms such as fatigue, hair loss, joint/muscle aches, rashes, unexplained fevers, and other mysterious symptoms -- but no diagnosis -- there's Living Well With Autoimmune Disease: What Your Doctors Don't Tell You...That You Need to Know. The book was just published in early October, 2002 by HarperCollins. Website: www.autoimmunebook.com.

For you and the people in your life who have a diagnosed autoimmune disease, or who have symptoms such as fatigue, hair loss, joint/muscle aches, rashes, unexplained fevers, and other mysterious symptoms -- but no diagnosis -- there's Living Well With Autoimmune Disease: What Your Doctors Don't Tell You...That You Need to Know. The book is for anyone with Graves' disease, Hashimoto's disease, or your family and friends who have any of the 80 autoimmune diseases, including:

Multi-Organ Syndromes -- Including Lupus, Mixed Connective Tissue Diseases, Sarcoidosis, Sjögren's Syndrome
Endocrine Conditions -- Including Thyroid Disease (Hashimoto's Thyroiditis, Graves' Disease), Diabetes, Addison's Disease, Autoimmune Oophoritis/Premature Ovarian Decline
The Pain/Fatigue Syndromes -- Including Chronic fatigue immune dysfunction syndrome (CFS/CFIDS), Fibromyalgia

Hair and Skin Diseases -- Including Scleroderma/Crest Syndrome, Alopecia, Psoriasis, Vitiligo, Pemphigus
Gastrointestinal Conditions -- Including, Inflammatory bowel diseases (IBDs) / Ulcerative Colitis, Crohn's Disease, Celiac Disease/Celiac Sprue, Pernicious Anemia
Joint and Muscle-Related Conditions -- Including Rheumatoid Arthritis, Spondyloarthropathies: Reiter's Syndrome and Ankylosing Spondylitis
Neuromuscular Conditions -- Including Multiple Sclerosis, Raynaud's Phenomenon, Guillain Barré Syndrome, Myasthenia Gravis

Don't forget that you can order the book from Iherb.com for a special rate of $10 by going to Iherb.com's online store.

You can also order the book from Amazon.com for $10.47 plus shipping, by clicking here.

Phone Orders: to order either book by phone, call Iherb.com tollfree at 1-888-792-0028.

NOTES FROM MARY: A TRIBUTE TO PAT SHOMON

Some of you know that my mother, Pat, who ran the home office for the my print newsletter, has been battling lung cancer for more than two years. She was here at my house for the holidays, and after returning to Florida, she had to go into the hospital to have a procedure done to help drain some fluid from her lungs during the first week of January. After the procedure, they told us her right lung was entirely collapsed, her cancer had spread, and that she had 3 to 6 months to live. They recommended she contact hospice. They then proceeded to recommend draining the working lung, to prevent infection or collapse.

Here are some excerpts from emails I was sending to family and friends to update them on my mother's condition, from both my home, and later, from Florida...

WEDNESDAY JANUARY 15TH

My mom is still in the hospital...she's having some sort of procedure done on her good lung in order to prevent it collapsing or filling with fluid. In the meantime, she's not getting pain meds or other things she needs in a timely manner...with 20 patients for every nurse, you apparently have to have a screaming hissy fit every time you need anything. It's all I can do not to get on a plane, and not go to that hospital and start taking names... But they don't want me to come now.

They've met with hospice and have figured out what sorts of services are available. I still don't know when they want me to come -- right now, my mom says she wants me to wait till she's gotten organized. I think she's holding me in reserve for when she can no longer manage her medical situation...

(NOTE: I decided to go ahead and fly down to Florida on Sunday the 18th)

TUESDAY JANUARY 21ST

Mom is home (we got her home late Tues p.m.) -- what a medical adventure that was.

Met with hospice team at the hospital before we left. I am amazed and impressed with hospice...they've been fantastic beyond belief.

We spent all day yesterday getting things organized...all the equipment arrived, the nurse came and I got all the medicines organized, and learned how to work with the morphine, we got the room organized with all the medical supplies...went straight from 8 a.m. till 11 p.m. without stopping. My aunt is here, she did about 10 loads of laundry, my cousin is here too, she got in from NJ at 5 p.m., and then gave my mother a foot massage for an hour.

All in all, my mother is MUCH happier, and far more comfortable physically here. It's amazing how different things are when she can sleep, eat and get medication on HER schedule, vs. the hospital's.

We've all ended up with our roles. I'm medical director, drug dispense, scheduler and project manager, Dad is production, facilities, equipment and purchasing manager, my Aunt is head of housekeeping (laundry, and home organization) and my cousin is personal care!

Today we had another nurse visit, my cousin shampooed my mom, I did all the medications all day, and am cooking dinner, my Aunt reorganized the fridge, Dad did the shopping, so we're all working hard, and spending good time with my mom in the midst. Mom even had enough energy to get wheelchaired from bedroom to living room to have lunch at the table with us. Given that over the weekend, we thought it was pretty likely she was dying and wouldn't make it out of the hospital, this is a huge thing.

I've decided to stay through till the 7th of Feb (originally was supposed to go home last nite, and then come back the 1st, but I need to be here to help with the meds and such.)

MONDAY JANUARY 27TH

My mom has transitioned into the early stages of dying. She's moving in and out of lucidity, eating and drinking little, has reported seeing dead relatives, but is having amazingly clear conversations with us as well. She's in no pain, and is totally comfortable, and has said "if I realized that your loved ones come for one, and that everyone around you gives you so much love, and you would be at so much peace, I'd tell everyone that dying is lovely!"

She's simply utterly amazing!

My husband and daughter and my brother are all coming in the 8 p.m. range tonight, and I think she's holding out to see them. Then my guess is she will either die, or slip into a coma.

The chaplain, a nun, came today and prayed with her and gave her communion, and told us my mom is very much at peace, with one leg in our world, and one in the next. It certainly seems that way...Mom is predicting things for the future, giving us all advice, and it's really quite astounding.

It's the hardest thing I've ever done, but an incredible privilege to be here with her.

We have opera music, flowers, and lots of love all around her, and she's at peace and in comfort. What more could we ask given the circumstance.

FRIDAY JANUARY 30TH

My Mom died last nite at 9:40 p.m. eastern.

We had called the local priest to come...she was not lucid at all yesterday, and was breathing quite raspy and irregularly all day. He came at 9:30 p.m. and was wonderful...did a short service, and then called out to her and quite firmly but lovingly told her it was her time, that God was waiting.

He left, and ten minutes later, she took her last breath, with all of us by her side.

The hospice nurse came, and cleaned her up and I picked out a beautiful dress and strappy sandals she loved. The nurse dressed her, and I put on some makeup for her. She is having a closed casket, but she looks peace, and so beautiful.

Gratefully, my daughter slept through it all, and had given Grandma a big nite nite kiss before she went to sleep. She drew a lovely picture of heaven which is tucked in Pat's hands, along with her rosary.

Hug those you love tight for me, everyone, because life is so so incredibly precious...

WEDNESDAY FEBRUARY 5TH

I gave the eulogy at my mother's funeral, and if you'd like to see it, I've included it online: http://www.thyroid-info.com/articles/patshomon.htm

* * *

ADDITIONAL NOTES

Every single person from the hospice, from the nurses to the home health aides, to the chaplains, to the delivery people, were simply amazing. The respect and caring for not only my mother, but my entire family, was astounding, and life-affirming, and allowed us to care for my mother with greater strength for us all, and comfort for her. If you aren't familiar with hospice, check out the programs in your own area, and consider volunteering time or resources. They are doing an incredibly important thing in this world to help people live well.

Live well,

-- Mary

ANOTHER KEY RESOURCE!!
SUBSCRIBE TO THE AUTOIMMUNE REPORT!

In conjunction with the book's launch, my new newsletter, The Autoimmune Report, comes out monthly, covering the issue of autoimmune disease specifically. If you're interested, sign up now!! Sending an email to autoimmune-subscribe@topica.email-publisher.com with "Subscribe Autoimmune" in the subject for news and updates.

"Sticking Out Our Necks" email edition is published monthly by Mary Shomon. Please invite your friends to subscribe! Send them a copy with your recommendation. "Sticking Out Our Necks" is copyright 1997-2003 by Mary Shomon.
Web: http://www.thyroid-info.com
Email: thyroidnews@thyroid-info.com
Regular mail:

Mary Shomon
P.O. Box 0385
Palm Harbor, FL 34682
Fax: 425-977-1175

Sticking Out Our Necks and this website are © Copyright Mary Shomon, 1997-2003. All rights reserved. Mary Shomon, Editor/Webmaster
All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician or health practitioner before starting a new treatment program. Please see our full disclaimer.