Did generic thyroid tablets deprive Susanthika of an Olympic medal?

by D. P. Atukorale

(September 03, Colombo, Sri Lanka Guardian) According to a report published in a local newspaper by one of the journalists writing from Beijing immediately after Susanthika qualifiedto run in the 200 meters semi finals in the Beijing Olympics she had said after she finished third in a second round heat on August 19: " I know I am not feeling the best. I feel extremely tired and worn out after every race. It is strange because I never had the feeling before. I think it is my thyroid again for which I am under constant medication. My doctor has increased the dose of medication". She had said so in exasperation.

I understand that Susanthika returned to the island on the 28th. One wonders whether the symptoms mentioned by her are due to hypothyroidism (deficiency of thyroid hormones) precipitated by her taking the generic thyroxine tablets which she may have bought prior to her departure for Beijing for the Olympics. It is common knowledge among medical personal that the hormone thyroxine is prescribed to patients suffering from hypothyroidism.

I am not at all questioning the clinical experience and the qualifications of the endocrinologist (physician who specialises in the study of anatomy, physiology and pathology of the endocrine system and of the treatment of endocrine problems; i.e.problems due to malfunction of ductless glands which secrete hormones into the blood stream) or the physician who has been treating Susanthikas thyroxine hormone deficiency. As far as I am aware there are three different brands of thyroxine tablets in our pharmacies at present. Out of these, the generic thyroxine tablets are the cheapest and cost only 29 cents per 50 microgram tablet, whereas the branded thyroxine tablet manufactured in U.K., which I invariably prescribe to patients now costs about Rs. 4/-r per 50 microgram tablet. I was told by a highly experienced endocrinologist that he never prescribe the cheap thyroxine tablets as they were not effective, and that he always prescribes branded thyroxine which is very effective, even though its price is comparatively high.

We cardiologists occasionally come across cardiac patients suffering from hypothyroidism. Of late, I have come across a few of my heart patients with hypothyroidism who had bought generic thyroxine tablets and even after increasing the dose of thyroxine (the SPC generic) from 50 microgram per day to 200 micrograms per day, the signs of hypothyroidism (thyroid hormone deficiency such as increase in weight, coldness of hands and feet, hoarseness of voice, puffiness of face, hands and feet, anorexia (loss of appetite), constipation, tiredness weakness and difficulty in breathing had not subsided at all, but had become worse. On the advice by the consultant endocrinologist who is attached to a leading private hospital in Colombo, he insisted that the generic drug sold be avoided. The few patients who thereafter took the branded thyroxine tablets (which cost about four rupees per 50 microgram as against the 29 cents tablets, were found within two to three weeks to have made a remarkable improvement in their thyroid status and their symptoms such as constipation, difficulty in breathing, weakness, coldness of the extremities disappeared and their weight also came down with the use of 50 to 75 microgram of the brand drug.

When I contacted one of the biggest pharmacies in Colombo recently, the manager informed me that they have stopped selling generic thyroxine in view of the many complaints they had received about the locally manufactured generic thyroxine from patients.

I must emphasise that the effective imported thyroid tablets are also available and it is often the patients themselves, who, in their ignorance, opt for the cheap 29 cent tablet when they find that the imported tablet costs as much as four rupees each.

It is high time the Drug Regulatory Authority (D R A) sent a few of the generic thyroxine tablets (manufactured in Sri Lanka) to a foreign country for quality testing as, far as I am aware, there are no facilities to do the quality control tests on hormone tablets in Sri Lanka.

Did Susanthika buy the generic Thyroxine tablets?

It is interesting to find out whether Susanthika bought the (dud) thyroxine tablets prior to her departure for the Olympics in Beijing and if so the question arises whether the generic (dud) thyroxine tablets deprived Susanthika of an Olympic medal.
- Sri Lanka Guardian