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Welcome to the Quality Counts. For those health conscious consumers and medical professionals that are looking to purchase nutritional supplements, vitamins, herbs, learning about medications, losing weight, health food, low carbs, high protein nutrition, and exercise, you have come to the right place. Quality Counts serves both the medical practitioner and consumer interested in nutritional therapy and alternative medicine.
Home > Health Conditions > Hypothyroidism
Hypothyroidism
Popular Medications Popular Supplements Alternative News CME
The T3 Controversy General Information Other News Related Searches Related Sites
Popular Medications:
Popular Supplements:
Alternative News:
-
Selenium and
the Thyroid: A Close-Knit Connection - J Clin Endocrinol Metab. 2010 Sep 1 -
"Maintenance of "selenostasis" via optimal intake not only aids preservation of
general health but also contributes substantially to the prevention of thyroid
disease" - See
selenium products at iHerb.
-
Effect of Zinc Supplementation on Thyroid Hormone Function. A Case Study of
Two College Females - Ann Nutr Metab. 2007 May 30;51(2):188-194 -
"Zinc supplementation appeared to
have a favorable effect on thyroid hormone levels, particularly total T(3),
and RMR"
-
Thyroid
Deficiency - Life Extension Magazine, 9/04
- Natural Support for Hypothyroidism - Dr. Murray's Natural Facts, 9/10/03
- Does soy affect thyroid gland function? - Natural Foods Merchandiser, 7/03
- Hypothyroidism More Common than Previously Recognized - New Hope Natural Media, 4/24/03 -
"Hypothyroidism can result in a wide array of symptoms, including
fatigue, depression, cold hands and feet, dry skin, fluid retention, hair loss, menstrual irregularities, infertility and elevated serum cholesterol"
- The Importance of Thyroid Supplementation - Life Enhancement Magazine, 11/99
CME:
The T3 (triiodothyronine) controversy (also see my triiodothyronine page):
-
T3 augmentation of SSRI resistant depression - J Affect Disord. 2006
Apr;91(2-3):211-5 - "The women took
a mean daily dose of 40.6 mug of T3 for a mean duration of 3.75 weeks, while
the men were on a mean daily dose of 43.8 mug of T3 for 3.5 weeks. T3
augmentation was associated with a statistically significant drop (p<.003)
in the mean HAMD at end of the three weeks compared to baseline scores"
-
T3 augmentation of SSRI resistant depression - J Affect Disord. 2006 Feb
14 - "T3 augmentation was associated
with a statistically significant drop (p<.003) in the mean HAMD at end of
the three weeks compared to baseline scores ... T3 augmentation resulted in
improvement of mood scores"
-
Combinination Levothyroxine/Liothyronine Shows No Obvious Benefit Over Levothyroxine Alone in Patients With Primary Hypothyroidism - Doctor's Guide, 12/11/03 -
"Patients who are treated with a combination of levothyroxine plus liothyronine for primary hypothyroidism gained no apparent benefit compared with patients treated with levothyroxine monotherapy"
- Combination Therapy No Better Than T4 Alone for Primary Hypothyroidism - Medscape, 12/9/03
- Use OF T3 Thyroid Hormone to Treat Depression - DrMirkin.com, 5/19/01 -
"some people become depressed when they take just T4 and their depression can be cured when they take both
thyroid hormones, T3 and T4"
- T3---fibromyalgia, hypothyroidism, thyroid hormone resistance - drlowe.com
- Wilson's Thyroid Syndrome -
"Conversion of T4 to T3 can also be impaired by glucocorticoids" - Maybe that is the mechanism by which cortisol causes depression,
and if so, could T3 then cure the depression? - Ben
- Thyroid Hormone Replacement Therapy - Horm Res 2001 Jan;56 Suppl S1:74-81 -
"Desiccated thyroid contains both thyroxine
(T(4)) and triiodothyronine (T(3)); serum T(3) frequently rises to supranormal values in the absorption phase, associated with palpitations. Liothyronine
(T(3)) has the same drawback and requires twice-daily administration in view of its short half-life ... recent animal experiments indicate that only the combination of T(4) and T(3) replacement, and not T(4) alone, ensures euthyroidism
in all tissues of thyroidectomized rats ... It could well be that a slow-release preparation containing both T(4) and T(3) might improve the quality of life, compared with T(4) replacement alone, in
some hypothyroid patients"
- Adding Natural Hormone Boosts Brain Function In Hypothyroidism - Doctor's Guide, 2/11/99
- T3 Triiodothyronine Drugs Improve Quality of Life for Hypothyroidism - thyroid-info.com
- Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism - N Engl J Med. 1999 Feb 11;340(6):469-70 -
"among 15 visual-analogue scales used to indicate mood and physical status, the results for 10 were significantly better after treatment with thyroxine [t4] plus triiodothyronine [t3]"
- Depression Management - ContinuingEducation.com, exp. 12/31/02 - See table six, recommends 5 - 50 mcg T3, 100 mcg (.1 mg) T4
General Information:
-
Hypothyroidism - American Academy of Family Physicians
- Hypothyroidism - emedicine.com
-
Hypothyroidism - FamilyDoctor.org
- Hypothyroidism - Intelihealth
-
Hyperthyroidism and Hypothyroidism - American Association of Clinical Endocrinologists
- Know Your Health Numbers - CBS, 2/17/03 -
"Your thyroid level should be between .4 and 5. Thyroid disease can lead to
dangerously rapid or slow heart-beat. Symptoms can include sluggishness, weight gain and depression"
- Thyroid and Aging - The Golden Years - MedicineNet.com, 6/01 -
"Approximately 25% of the elderly population suffer from some form of mental illness. A significant number of
these cases may be related to thyroid disease"
- Amazon.com books on hypothyroidism
- Treatments for hypothyroidism
 - Medifocus.com
Other News:
-
Subclinical Thyroid Dysfunction and the Risk of Heart Failure in Older
Persons at High Cardiovascular Risk - J Clin Endocrinol Metab. 2012 Jan
11 - "Over 3.2 yr follow-up, the rate of heart
failure was higher for subclinical hyperthyroidism compared with
euthyroidism [age- and sex-adjusted hazard ratio (HR) = 2.93, 95% confidence
interval (CI) = 1.37-6.24, P = 0.005; multivariate-adjusted HR = 3.27, 95%
CI = 1.52-7.02, P = 0.002). Subclinical hypothyroidism (only at threshold
>10 mIU/liter) was associated with heart failure (age- and sex-adjusted HR =
3.01, 95% CI = 1.12-8.11, P = 0.029; multivariate HR = 2.28, 95% CI =
0.84-6.23). There were no strong evidence of an association between
subclinical thyroid dysfunction and cardiovascular events or mortality,
except in those with TSH below 0.1 or over 10 mIU/liter and not taking
pravastatin. Conclusion: Older people at high cardiovascular risk with low
or very high TSH along with normal free T(4) appear at increased risk of
incident heart failure"
-
High
normal thyroid-stimulating hormone is associated with arterial stiffness in
healthy postmenopausal women - J Hypertens. 2012 Jan 5 -
"Individuals with serum TSH greater than 2.5 μIU/ml
had significantly higher values of PWV when compared with individuals with
TSH levels below 2.5 μIU/ml (9.68 ± 1.97 vs. 8.54 ± 1.83 m/s; P = 0.030). In
multivariate analysis, age, insulin resistance and TSH above 2.5 μIU/ml were
the only significant predictors of PWV (TSH, β-coefficient = 0.222;
P = 0.014). No associations were found between the remaining markers and
levels of thyroid hormones, whereas thyroid antibodies were not associated
with any of the arterial markers"
-
Endogenous subclinical thyroid disorders, physical and cognitive function,
depression and mortality in older individuals - Eur J Endocrinol. 2011
Jul 18 - "To what extent endogenous subclinical
thyroid disorders contribute to impaired physical and cognitive function,
depression and mortality in older individuals remains a matter of debate ...
Participants with overt thyroid disease or use of thyroid medication were
excluded ... Sixty-four (5.3%) individuals had subclinical hypothyroidism
and 34 (2.8%) had subclinical hyperthyroidism. As compared to euthyroidism
(n=1121), subclinical hypo- and hyperthyroidism were not significantly
associated with impairment of physical or cognitive function, or depression.
On the contrary, participants with subclinical hypothyroidism did less often
report more than one activity limitation (odds ratio 0.44, 95% confidence
interval (CI) 0.22 to 0.86). After a median follow-up of 10.7 years 601
participants were deceased. Subclinical hypo- and hyperthyroidism were not
associated with increased overall mortality risk (hazard ratio 0.89 , 95% CI
0.59 to 1.35 and 0.69, 95% CI 0.40 to 1.20, respectively). Conclusions. The
present study does not support disadvantageous effects of subclinical
thyroid disorders on physical or cognitive function, depression or mortality
in an older population"
-
Hypothyroidism Shows Strong Association With Type 2 Diabetes, Screening
Recommended - Doctor's Guide, 4/18/11 - "The
cross-sectional study comparing 1,848 adult patients with type 2 diabetes
with 3,313 individuals without diabetes, showed the prevalence of
hypothyroidism on the study group to be 5.7% compared with 1.8% in the
control group"
-
Thyroid hormone controls the eye‘s visual pigments throughout life -
Science Daily, 3/29/11 - "in mature cones of mice
and rats the production of visual pigment is regulated by thyroid hormone.
It is assumed that this mechanism exists in all mammals, including humans.
If so, the adult-onset of thyroid hormone deficiency would affect colour
vision ... Studies in mice have shown that thyroid hormone also plays an
important role in the development of the eye and particularly the cone
visual cells. In the retina of the eye, the cones are the visual cells
responsible for colour vision"
-
Familial
Longevity Is Associated with Decreased Thyroid Function - J Clin
Endocrinol Metab. 2010 Aug 25 - "We found that a
lower family mortality history score (less mortality) of the parents of
nonagenarian siblings was associated with higher serum TSH levels (P =
0.005) and lower free T4 levels (P = 0.002) as well as lower free T3 levels
(P = 0.034) in the nonagenarian siblings"
-
Metabolic cardiovascular disease risk factors and their clustering in
subclinical hypothyroidism - Clin Endocrinol (Oxf). 2010
May;72(5):689-95 - "There appears to be a
significant increase in a cluster of metabolic CVD risk factors among people
with subclinical hypothyroidism"
-
A high
normal TSH is associated with the metabolic syndrome - Clin Endocrinol (Oxf).
2010 May;72(5):696-701 - "Subjects with a TSH in the
upper normal range (2.5-4.5 mU/l, n = 119) had a significantly higher BMI
(30.47 +/- 0.57 vs. 28.74 +/- 0.18 kg/m(2), P = 0.001) and higher fasting
triglycerides (1.583 +/- 0.082 vs. 1.422 +/- 0.024 mmol/l, P = 0.023), and
their likeliness for fulfilling the ATP III criteria of the metabolic
syndrome was 1.7-fold increased"
-
Metformin Lowers Serum
TSH Levels in Diabetics With Hypothyroidism - Medscape, 10/2/09
-
A high
normal TSH is associated with the metabolic syndrome - Clin Endocrinol (Oxf).
2009 Sep 10 - "Subjects with a TSH in the upper
normal range (2.5 to 4.5 mU/l, n = 119) had a significantly higher BMI
(30.47 +/- 0.57 vs. 28.74 +/- 0.18 kg/m(2), p = 0.001) and higher fasting
triglycerides (1.583 +/- 0.082 vs. 1.422 +/- 0.024 mmol/l, p = 0.023), and
their likeliness for fulfilling the criteria of the MS was 1.7-fold
increased"
-
Hypothyroidism In Women Associated With Liver Cancer - Science Daily,
5/8/09 - "Women with a history of hypothyroidism
face a significantly higher risk of developing liver cancer ... Whether and
why hypothyroidism causes HCC is not clear ... However, the association
between hypothyroidism and NASH can be explained by the underlying
hyperlipidemia, decreased fatty acid oxidation insulin resistance and lipid
peroxidation in patients with hypothyroidism"
-
Antipsychotics Significantly Decrease Free Thyroid Hormone Concentrations
- Doctor's Guide, 9/4/08 - "In patients who receive
antipsychotic medication, levels of free thyroxine and free triiodothyronine
show significant decreases that may affect thyroid hormone functional
activity in some tissues, such as the liver"
-
Higher Serum Free Thyroxine Levels Are Associated with Coronary Artery
Disease - Endocr J. 2008 May 23 - "The relative
risk (RR) for CAD in highest tertile of FT(4 )showed increased risk compared
with the lowest tertile (RR 1.98; 95% CI 0.98-3.99, p<0.001). Our study
showed that FT(4 )levels were associated with the presence and the severity
of CAD. Also, this study suggests that elevated serum FT(4 )levels even
within normal range could be a risk factor for CAD"
-
Erectile
Dysfunction in Patients with Hyper- and Hypothyroidism: how Common and
Should We Treat? - J Clin Endocrinol Metab. 2008 Feb 12 -
"ED was more prevalent in patients with
hyperthyroidism and hypothyroidism compared to controls ... ED is extremely
common in males with dysthyroidism. Treatment of the latter restores
erectile function"
-
Hypothyroidism Tied to Excess Small Intestinal Bacteria - Medscape,
12/17/07 - "small intestinal bacterial overgrowth
(SIBO) ... A hydrogen glucose breath test indicated SIBO in 27 of the
patients (54%) versus 2 (5%) of the controls. Symptoms such as abdominal
discomfort, flatulence and bloating were significantly more prevalent in the
SIBO Group. After treating these patients with 1200 mg rifaximin for a week,
there was a significant improvement in the symptoms"
-
Association between serum TSH, free T4 and serum liver enzyme activities in
a large cohort of unselected outpatients - Clin Endocrinol (Oxf). 2007
Oct 17 - "GGT and ALT concentrations increased
steadily across the increasing TSH categories (P < 0.0001 for trends),
ranging from mean values of 36 to 62 U/l for GGT and from 29 to 41 U/l for
ALT, respectively. Similarly, there was a negative, graded, relationship
between serum GGT and ALT concentrations and free T4 categories"
-
Even
Mild Thyroid Problems Double Risk Of Heart Condition - Science Daily,
10/5/07 - "individuals who had a TSH level equal or
greater than 10 mU/L had a two-fold risk of developing heart failure,
compared to those who had normal thyroid levels"
-
Cardiac effects of l-thyroxine administration in borderline hypothyroidism
- Int J Cardiol. 2007 May 9 - "subclinical
hypothyroidism is associated with a cardiac dysfunction, even when this is
very mild (i.e. with serum TSH still comprised in the normal range), and
show that these abnormalities are reversible with l-T(4) replacement
therapy"
-
What
Is The Role Of Thyroid Hormones In Sleep Regulation? - Science Daily,
8/8/07
-
Hypothyroidism Clearly Linked To Mood Swings - Science Daily, 6/4/07
-
Treatment Of Thyroid Disease Reduces Tiredness And The Risk Factors For
Heart Disease, According To Study - Science Daily, 5/29/07 -
"treatment for a shortage of the
hormone thyroxine lowers cholesterol, reverses weight gain and reduces the
risk factors for heart disease"
-
l-thyroxine augmentation of serotonergic antidepressants in female patients
with refractory depression - J Affect Disord. 2007 Feb 6 -
"The study included 17 female
patients ... After four weeks of l-thyroxine augmentation, the remission,
assessed as 7 or less points on Hamilton Depression Rating Scale (HDRS) was
obtained in eleven patients (64.7%). Five other patients (29.5%) had
responded (reduction>50% on HDRS) and one patient did not show an
improvement"
-
The beneficial effect of L-thyroxine on cardiovascular risk factors,
endothelial function and quality of life in subclinical hypothyroidism:
randomised, crossover trial - J Clin Endocrinol Metab. 2007 Feb 13 -
"Subclinical hypothyroidism (SCH) is
defined as raised serum thyrotropin (TSH) levels with circulating thyroid
hormones within the reference range ... L-thyroxine treatment reduced TC
(versus placebo) from 231.6 to 220 mg/dL, p<0.001; LDL cholesterol from
142.9 to 131.3 mg/dL, p<0.05; waist-hip ratio from 0.83 to 0.81, p<0.006;
and improved FMD from 4.2 to 5.9% ... SCH treated by L-thyroxine leads to a
significant improvement in CV risk factors and symptoms of tiredness"
-
Stomach Acid May Affect Thyroid Drug - WebMD, 4/26/06
-
No Increased Cardiovascular Risk if Mildly Underactive Thyroid Left
Untreated - Doctor's Guide, 3/2/06
-
Thyroid-Heart Risks Become Clearer - WebMD, 2/28/06
-
New Data Says a Mild Case of Underactive Thyroid Disease Should Be Left
Alone - Doctor's Guide, 1/12/06
-
Thyroid Condition Associated with Increased Heart Failure Risk in Older
Adults - Doctor's Guide, 12/1/05 -
"Subclinical hypothyroidism (SH) ...
the incidence of CHF during a 4-year follow-up period was significantly
increased in patients with moderate and severe SH"
-
For Thyroid Hormones, How Low Is Too Low? - New York Times, 11/8/05 -
"My good friend Marty Surks is not
impressed and doesn't think you should treat patients with a T.S.H. between
5 and 10, but there's mounting evidence that over 2.5 is abnormal"
-
Pill 'could lead to longer lives' - BBC News, 3/31/05 -
"the mice with the highest metabolic
rate lived around 25% longer than those with the lowest ... When mice were
given thyroxine, they had increased metabolic rates and lived longer ...
However, a leading specialist in human hormone disorders said the findings
would "not be true for humans""
-
Underactive Thyroid Cuts Breast Cancer Risk - WebMD, 2/14/05 -
"an underactive
thyroid was shown to protect against developing breast cancer. The study also showed that women who developed breast cancer and who had an underactive thyroid had a less aggressive disease compared
with women with a normally functioning thyroid"
- Women With Hypothyroidism Appear to Have Lower Risk of Breast Cancer - Doctor's Guide, 2/14/05
- New FDA Approved Test Detects Thyroid Disease in Minutes - Doctor's Guide, 12/29/04
- Subclinical Hypothyroidism Increases Risk of Heart Disease? - Physician's Weekly, 11/15/04 -
"heart disease was 2.6-times more
likely among participants with insufficient thyroid function than in those with normal thyroid function"
- Atypical Depression: Thyroid Link Still Alive - WebMD, 3/15/04
- Autoimmune Thyroid Disease Linked to Depression - Medscape, 3/15/04
- Effects of Levothyroxine on Bone Mineral Density Remain Unclear - Doctor's Guide, 3/3/04
-
Subclinical Thyroid Disease - JAMA. 2004;291:239-243 -
"Most persons found to have subclinical
thyroid disease will have TSH values between 0.1 and 0.45 mIU/L or between 4.5 and 10 mIU/L, for which the benefits of treatment
are not clearly established; treatment may be beneficial in individuals with serum TSH lower than 0.1 mIU/L or higher than 10 mIU/L"
- Levothyroxine Decreases Risk of Atherosclerosis in Women with Subclinical Hypothyroidism - Doctor's Guide, 5/18/03 -
"Compared to controls, the
hypothyroid women had significantly elevated levels of fibrinogen, plasminogen activator inhibitor (PAI-1), and factor VII (P<0.0001). They also had lower levels of
antithrombin III activity (P<0.05). When the hypothyroid women were treated with levothyroxine, they had significant decreases in both PAI-1 and factor VII ... These findings show that subclinical
hypothyroidism may play an important role in promoting both hypofibrinolytic and hypercoagulable states,
and therefore leading to the development of atherosclerosis in female patients"
- Underactive Thyroid Lowers Breast Cancer Risk - WebMD, 4/10/03
- Treatment of Subclinical Hypothyroidism Advocated - Doctor's Guide, 4/7/03 -
"Adverse effects fall into four general categories, according to
Dr. Gardner -- neuropsychiatric symptoms, abnormal lipids, altered myocardial function, and greater risk of atherosclerotic heart disease ... Adding to the controversy, he added, is growing evidence that the upper limit of normal serum TSH concentration should be less than 2.5-3.0 U/mL
and not the current levels of 5.0-5.5 U/mL"
- Self-Medicating With Synthroid - Medscape, 3/11/03
- Married to TSH: Something Old, Something New - Doctor's Guide, 2/18/03
- Elevated C-Reactive Protein, Homocysteine Values In Hypothyroidism Possible Risk Factor For Coronary Heart Disease - Doctor's Guide, 2/10/03
- Third-generation Assay Effective for Surveillance of Levothyroxine Treatment - Doctor's Guide, 1/21/03
- Thyroxine replacement therapy reduces polyarthralgia symptoms in patients with chronic lymphocytic thyroiditis - Doctor's Guide, 9/13/02
- No Link Found Between Thyroid Dysfunction and Depression or Anxiety - Doctor's Guide, 8/16/02
- Oral Contraceptive Use Helps Prevent Goitre Development - Doctor's Guide, 8/1/02
- Women of Childbearing Age May Need Earlier Thyroid Screening - Doctor's Guide, 6/20/02
- FDA Approves First Prescription Drug Using Penwest's PROSOLV®; MOVA To Market Thyroid Treatment Formulation - Doctor's Guide, 4/26/02 -
"is a sodium levothyroxine dosage form indicated for the treatment of hypothyroidism and the suppression of thyroid stimulating hormone"
- Selecting The Dose Of Single Radioiodine Therapy For Goitre - Doctor's Guide, 4/18/02
- Female Sexual Dysfunction, Thyroid Trouble May Be to Blame - WebMD, 3/21/02 -
"she has seen no published studies evaluating the frequency of thyroid
disease in women with sexual dysfunction issues ... But, with the exception of sexual issues related to menopause, I see it more often than anything else in my female patients"
- Synthroid and Osteoporosis - MedicineNet.com, 3/20/02
- Thyroid Nodules Management - MedicineNet.com, 3/20/02
- Smoking Responsible For Half Of Cases Of Goiter In Areas Of Low Iodine - Doctor's Guide, 3/8/02
- Thyroid Disorders are Inherited, Often Hidden - Doctor's Guide, 2/11/02 -
"Our research shows that there is a large
population of Americans who suffer from hidden thyroid disorders"
- Thyroid Disease Increases Birth Defects - WebMD, 1/18/02
- Thyroid Disease Raises Risk of Birth Defects - Doctor's Guide, 1/15/02
- Bipolar Patients Sensitive to Thyroid Function Variations - Doctor's Guide, 1/8/02 -
"They studied 65 patients in the depressed phase of bipolar
I disorder to test the hypothesis that patients with lower thyroid function, even within the normal range, might have a poorer response to treatment initially ... Outcomes were relatively poor unless patients had FTI
[free thyroxine index] values above the median and TSH values below the median"
- Thyroid Hormones Accelerate Depressive Response to Drug Therapy - Doctor's Guide, 10/30/01
- Thyroid-Stimulating Hormone Level Inadequate Measure Of Hypothyroidism Severity - Doctor's Guide, 6/24/01
- Thyroid Hormone Not Necessary To Shrink Thyroid Nodules - Doctor's Guide, 6/22/01
- Human Recombinant Thyroid-Stimulating Hormone Use Eliminates 1-Thyroxine Suppressive Therapy - Doctor's Guide, 1/12/01
- FDA Approves Unithroid (Levothyroxine), Thyroid Hormone Replacement, For Use In Adults And Children - Doctor's Guide, 8/23/00
- U.S. FDA clears treatment for underactive thyroid - CNN, 8/23/00
- Calcium Supplements May Interfere With Thyroid Treatment - WebMD, 6/6/00
- What Feels Like Stress May Call for a Thyroid Test - WebMD, 4/21/00
- Thyroid HRT No Better Than Placebo In Euthyroid Patients - Doctor's Guide, 3/17/00
- Thyroid HRT Potentially Dangerous - Doctor's Guide, 3/17/00
- Prevalence Of Thyroid Disease In US Higher Than Suspected - Doctor's Guide, 2/28/00
- Premature graying: Usually no cause for alarm - CNN, 11/10/99
- "Premature graying can occur with a number of
conditions, including hyperthyroidism, hypothyroidism and pernicious anemia"
- Hypothyroidism During Pregnancy Linked To Lower IQ For Child - Doctor's Guide, 8/19/99
- Low thyroid levels during pregnancy may lower child's IQ - CNN, 8/18/99
- Hair Loss and Thyroid Disease - About.com, 6/10/99
- Research Finds Most Patients Feel Better with Addition of T3, Not Levothyroxine (i.e., Synthroid) Alone!!! - about.com
- Depression and Thyroid Disease - about.com
- HELP! My TSH Is "Normal" But I Think I'm Hypothyroid - about.com, 11/10/97
- Undertreatment of Thyroid Disease Increasing Cardiovascular Risk - Doctor's Guide, 10/16/97
- Why Do You Insist on Synthroid Instead of Armour? -- A Patient's Letter - about.com
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