According to campaign's sponsor AbbVie -- founded in early 2013 as a spinoff of pharmaceutical giant Abbott Laboratories- "Follow the Script" is a "national empowerment campaign" designed to help raise awareness about the importance of diagnosing and treating hypothyroidism. At the campaign's website, www.followthescriptcampaign.com, Vergara shares her story.
As a thyroid patient advocate for almost twenty years, I'm always encouraged by publicity for thyroid issues, particularly hypothyroidism, which, with broad symptoms like fatigue, weight gain, depression, and hair loss, is often overlooked, misdiagnosed, and frequently stigmatized. Hypothyroidism is thought to affect at least 30 million people -- though some experts say it's more likely double that number, and that whatever the number, at least half are undiagnosed.
Landing Vergara as the face of the campaign is a major coup for AbbVie. She's beautiful, funny, and a mega-star of a hit show. Forbes magazine rated her as the top-paid television actress in television of 2012. There's no question that given Vergara's visibility, the campaign will have some positive impact on awareness of hypothyroidism -- and, more to the point, on sales of Synthroid. Still, it's a good time for hypothyroidism to get some positive awareness.
But it's also a good time for a reality check on thyroid cancer and hypothyroidism.
On Good Morning America, Vergara said that treating her hypothyroidism was simple. "You can fix it very easy." Added Vergara: "I hear so many people saying they have so many problems with their thyroid. I've never had a problem because I've taken control of it."
I recognize that Vergara's job as Synthroid spokesperson is to make the case that treating thyroid hypothyroidism is easy, and that life with hypothyroidism -- especially while taking Synthroid - is a simple matter of "taking control of it," But there are thousands of thyroid cancer patients, and millions of people with hypothyroidism, myself included, who would vehemently disagree. You can "take control" all you want and still not have an outcome as picture-perfect as Sofia Vergara's.
Fact: Some 2,000 people will die from thyroid cancer this year alone. Vergara is lucky in that she is a thyroid cancer success story, but she does not represent the varied experiences of thyroid cancer patients. While thyroid cancer is not common, it is the fastest growing cancer in the U.S., and the American Cancer Society estimates that about 60,000 new cases of thyroid cancer will be diagnosed this year. Often referred to glibly as the "good cancer" because common forms of thyroid cancer are often curable, a typical course for thyroid cancer patients can be daunting: surgical removal of the thyroid followed by radioactive iodine treatment to remove any remnants of the cancer, lifelong thyroid hormone replacement to treat the resulting hypothyroidism, and periodic scans to detect recurrence. Some thyroid cancer patients have multiple recurrences, serious complications from surgery, or the cancer spreads. Others, like the late Roger Ebert, end up with secondary cancers and life-changing, disfiguring complications.
Now, let's talk about hypothyroidism. Conventional doctors rely on one blood test, Thyroid Stimulating Hormone (TSH), to diagnose and manage hypothyroidism. Endocrinologists, however, cannot agree on what TSH level even constitutes hypothyroidism. And the TSH test doesn't even measure actual thyroid hormone in the body; it measures a pituitary hormone. TSH doesn't always correlate to actual levels of thyroid hormone -- thyroxine (T4) and triiodothyronine (T3) -- in the body. So TSH can be normal, but if T4 or T3 are low, a person can still be suffering from hypothyroidism and its symptoms.
While thyroid cancer left Vergara hypothyroid, that's not the case for the vast majority of hypothyroidism sufferers in the United States. Instead, they suffer from Hashimoto's thyroiditis, an autoimmune disease where the body creates antibodies that attack the thyroid, and gradually cause it to self-destruct. Hundreds of thousands are diagnosed each year. Symptoms can be debilitating, even dangerous: numbing fatigue, rapid weight gain, depression, anxiety, infertility, miscarriage, heart issues, low sex drive, cognitive problems, muscle and joint pain, and hair loss, among others. Even when TSH and other thyroid levels are in the normal range, most conventional doctors don't test for Thyroid Peroxidase antibodies (TPO), the marker for Hashimoto's disease, or treat the Hashimoto's if it's found. The result? A thyroid gland that slowly self-destructs, and can cause worsening hypothyroidism symptoms as it does.
Meanwhile, there's the issue of treatment. While the conventional world promotes levothyroxine (a synthetic form of T4, and Synthroid is the best-known brand of levothyroxine) as the only recommended hypothyroidism treatment, research has shown that a subset of people with hypothyroidism do not respond well. Their hypothyroid symptoms are not relieved unless their thyroid treatment also includes T3 -- either synthetic liothyronine (Cytomel is the brand name), or in FDA-regulated natural desiccated thyroid drugs like Armour Thyroid and Nature-throid.
The reality is that thyroid disease diagnosis and treatment is not a one-size-fits-all, cookie-cutter process with one test and one medication being the answer for every patient. While AbbVie's Synthroid campaign with Vergara will likely have some positive benefits for awareness, it is also a frustrating setback for millions of thyroid patients who can't get properly diagnosed, or simply don't feel well on the standard hypothyroidism treatment, despite valiant efforts to "take control of it."
For some undiagnosed and mistreated patients with hypothyroidism, "following the script" too closely could mean a lifetime of unnecessary illness.