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Thyroid disorders: An illness underestimated

Published on 29/08/17 at 11:17am

Dr Bogumila Urgatz, Medical Director, Department Global Medical Affairs & General Medicine and Endocrinology, Merck KGaA discusses thryoid problems and how the results of a study led them to launch a new campaign on the issue.

Did you know that thyroid disorders are among the most common diseases in the world? In fact, about 1.6 billion people worldwide are at risk, and the vast majority of those are women.

The hormones produced in the thyroid gland help regulate many different functions in the body, thus making symptoms of thyroid disorders very diverse. The inconspicuous symptoms make thyroid disorders difficult to spot and can lead to low awareness; for example, in the United States up to 60% of people who suffer from thyroid disease are unaware of their condition.

Although these statistics are concerning, the condition seldom receives a proportionate share of media attention as many types of thyroid disorder and their treatment have been well understood for many years. When there are innovations, they simply don’t generate the same attention (outside of clinical endocrinology circles) as rarer but more technologically “interesting” conditions. However, thyroid disorders, such as hypothyroidism, require urgent attention, as they can reduce quality of life and lead to serious health consequences, like heart failure and coma, if left untreated.

Thyroid disorders are a big focus at Merck. We’ve been at the forefront of the treatment of thyroid disorders for over 100 years, and are committed to raising awareness, improving diagnosis, and providing support for patients.

Understanding the patient

At Merck, we continuously carry out research in order to get a comprehensive understanding of people who suffer from thyroid disorders. Our aim is to learn as much as possible about who our patients are, what their diagnostic journey looks like, which challenges they encounter and how they can be better supported.

For example, a recent research project demonstrated why certain patients find it difficult to pinpoint thyroid disorders when they first present with symptoms, and how these are often ignored until more severe issues appear. Instead of seeking medical help, these patients typically attempt to self-treat their symptoms without any idea that a thyroid disorder is at the root of their problems. Interestingly, our research showed how decisions about diagnosis and care of thyroid disorder symptoms are strongly influenced by a range of cultural, economic, and social factors.  

Thus, raising awareness of thyroid disorders is of paramount importance to the well-being of patients. We work persistently to address gaps in knowledge by leading and supporting a variety of awareness activities aimed at helping both patients and healthcare professionals to connect the dots.

Insights to action

The insights gathered from our research have formulated the basis for our latest awareness campaigns. As thyroid disorders disproportionately affect women2,3 we wanted to find a way to reach women in a way that genuinely addressed some of the gaps in understanding. So in 2017 we commissioned a global survey among women that would form the backbone of a campaign to help shine light on the often overlooked symptoms of thyroid disorders.

The results of this survey showed a tendency for women to disregard some symptoms and attribute them to manifestations of a stressful lifestyle. For example, nearly half (49%) of respondents said they had blamed their lifestyle choices for feeling restless or having difficulty sleeping, while 40% blamed lifestyle choices for feeling depressed, anxious, and tired. In reality, a thyroid disorder could be the cause of such symptoms.

These results formed the basis of a new campaign ’It’s not you. It’s your thyroid.’ that aimed to help women recognize that they may be incorrectly blaming themselves for their thyroid disorder.

Visual social media content was a big element of our ‘It’s not you. It’s your thyroid.’ campaign to reach those who may have a thyroid disorder

To coincide with the launch of the campaign during International Thyroid Awareness Week (May 22‑29, 2017), we developed a host of educational materials that are featured on our dedicated website, thyroidaware.com. This website is designed to provide accurate and up-to-date information on the whole range of thyroid conditions, acts as a resource for anyone who is concerned that they may have a thyroid disorder or simply find out more about the thyroid gland.

Our responsibility

At Merck, our role is much more than providing patients with a treatment. Our commitment is to serve patients, physicians, and healthcare regulators by being an advocate for disease awareness, a responsible scientific authority on thyroid disorders, and a trustworthy collaborator in public‑private partnerships.

For instance, we are part of a longstanding partnership with Thyroid Federation International (TFI), an international network of patient support organisations. Over the past nine years we’ve worked closely with them to ensure that the voice of the patients is heard.

One of the projects I’m most proud to have been involved in is our partnership with the Indonesian Ministry of Health to promote screening of newborns across the region. Untreated congenital hypothyroidism leads to serious developmental and health complications when newborns are left undiagnosed and postnatal screening is still not standard practice in many areas across the globe. 

Although decreed a standard procedure by the Indonesian government in 2014, implementation of screening has been slow. In addition to working with the Ministry of Health to amplify key messages on thyroid disorders, we partnered with the Indonesian Pediatric Society to help pediatricians to diagnose the disease and become more aware of the condition as a whole.

Merck teams are also working to improve thyroid awareness through local partnerships and collaborative campaigns in many other regions across the globe, including China, the Middle East, and South America.

A recent meeting between Merck and the Ministry of Health in Saudi Arabia led to the signing of a Memorandum of Understanding

Innovation within an established treatment paradigm

Merck has a longstanding history in thyroid treatments, dating back to 1894 where Merck introduced desiccated sheep thyroid powder for the treatment of hypothyroidism in Germany.8 Levothyroxine, introduced by Merck in 1973, has become the standard of care for treatment of hypothyroidism, and is recommended by numerous international guidelines. Although treatment of hypothyroidism is well-established, more recent changes to our understanding of thyroid disorders have required changes to the therapy provided.

As treatment seeks to replace the natural thyroid hormone, dosages must be tailored to the individual and, as such, levothyroxine is available in doses ranging from 25 to 200 micrograms. In response to concerns expressed about levothyroxine products by healthcare professionals and patients that the potency of levothyroxine tablets may deteriorate prior to its expiry date, the FDA tightened the dosing specifications for levothyroxine tablets, reducing the dosing specification margin from 90 to 110% to 95 to105% in October 2007. In a similar move the Medicines Healthcare Regulatory Authority in the United Kingdom also tightened the upper potency limit over shelf life from 110% to 105%.

In response to this, and to ensure that patients were receiving the most precise dosages of treatment possible, we have reformulated our levothyroxine formulation to meet the 95‑105% potency specification guidelines, and are currently working hard to make it available to patients worldwide.

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