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that the goals in levothyroxine suppression in thyroid cancer are much different.  This is chemotherapy for us.  The implications of having a TSH a little out of the normal range is far more significant in thyroid cancer.  The narrow therapeutic window that you already use for thyroid hormone is much smaller when we're dealing with folks with thyroid cancer.  These very small changes can have important clinical events.  These are not just paper changes that we chase.  These are real events in the lives of our patients, and to our mind, product substitution with alternates that vary by really more than 5 to 10 percent would be unacceptable in the treatment of thyroid cancer patients.

Thank you.

DR. KIBBE:  Thank you, Dr. Tuttle.

Dr. Dickey.  I hope we're in the right order.  Richard Dickey?

DR. DICKEY:  Yes, sir.  Thank you.  Good afternoon and thank you for inviting us to testify today.

My name is Richard Dickey, and I'm a newly retired physician.  I practiced endocrinology for over 30 years and still practice as a volunteer in a local

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