General Medicine

» Elaine Moore - Letter to the Editor

Beth Harkness, Editor-in-Chief
Nuclear Medicine Technology
Society of Nuclear Medicine
Reston, VA 20190

Dear Ms. Harkness:

I would like to comment on your recent article Patient Misconceptions and Ethical Challenges in Radioactive Iodine Scanning and Therapy by M. Sara Rosenthal. In this article, Ms. Rosenthal uses my book, Graves' Disease, A Practical Guide and my personal website www.elaine-moore.com, which she inaccurately cites, as references to support her premises. However, neither of these resources contain the information she is referencing. Furthermore, Ms. Rosenthal previously rated my Graves' disease book as an excellent resource on Amazon.com, and she published my book Thyroid Eye Disease, Understanding Graves' Ophthalmopathy through her publishing company SaraHealth Press. Both of these books present identical views on radiation, yet she only uses the Graves' book as a reference.

The following are statements attributed to my book and website that aren't contained in these resources:

Specifically, Ms. Rosenthal stated that on my "listserv" (I don't manage or maintain a listserv) that I considered radiation-induced hypothyroidism as "unexpected." I have never stated this and in fact have written that hypothyroidism is an expected consequence of radioiodine ablation. Ms. Rosenthal states that I consider hypothyroidism "evidence of harm," because of this "unexpected" effect.

She also references my book as a resource for her statement that levothyroxine replacement hormone therapy could be construed as harmful. Having worked as a toxicologist for more than 20 years, I can't imagine anyone thinking levothyroxine is harmful, and I've never stated this.

Ms. Rosenthal also quotes me as saying that the risk of small bowel and thyroid cancer is increased after radioiodine ablation. My original reference from Frankly does indeed say that the risk of these cancers is small but significant. Long-term vigilance is recommended for those receiving radioiodine.

In addition, she uses my book as a resource for her comment that some advocates say that the TSH test should not be used to monitor patients with hypothyroidism. I have stated that the TSH test result can be misleading in patients with Graves' disease and that fact has been well established in the clinical laboratory. However, I have never said the TSH test should not be used, and I recommend it as the gold standard for screening patients for thyroid disease. However, the TSH test was never intended to be used to monitor patients on thyroid replacement hormone.

Ms. Rosenthal also mentions that I state that goitrogens "cure" Graves' disease. Nowhere have I ever written this, nor do I think this. I have consistently reported that goitrogens block iodine absorption, thereby limiting the amount of thyroid hormone that can be produced. I have never referred to there being a "cure" for Graves' disease because to my knowledge a cure is not available.

In addition, Ms. Rosenthal uses my book as a reference for the notion that triiodothyronine (T3) therapy alone is sufficient for treating hypothyroid patients. I have never reported or stated this, and I have only seen this suggested in Ridha Arem's book, The Thyroid Solution, as a therapy for depression not hypothyroidism.

I also object to Ms. Rosenthal's stereotypical statements regarding Japanese and European patients. She discusses autonomy yet denigrates patients who have their own views and suggests that views other than her own are ill founded.

Finally, Ms. Rosenthal states that when patients refuse RAI and are candidates for other treatment options, they should be informed of these options. According to HIPAA regulations, patients have a right to hear about all treatment options and their side effects at the time of their diagnosis. Information regarding other treatment options should not be withheld because a physician prefers the use of radioiodine.

As a laboratory professional, medical writer and patient advocate I feel that Ms. Rosenthal has performed a disservice with this article. She owes an apology to your readers and also to the writers she has misquoted and misrepresented in this poorly researched work.

Sincerely,

Elaine A. Moore, MT(ASCP), CLS