In the days after the Russian invasion of Ukraine, a local nonprofit began receiving an unusual request.
Many people were calling the NGO, Charity Fund Modern Village and Town, searching for insulin and other typical drugs – increasingly difficult to find as the war caused logistical issues throughout Ukraine, and even basic medications were made scarce in the areas under attack.
In addition to supplying hospitals and other health facilities with medical aid, the organization responds by searching for requested medications, and letting patients know where they can access them. In some cases, they’ll even acquire a medication for a specific patient.
But some people were searching for something more unusual: levothyroxine – a hormone replacement used by people whose thyroid glands have been removed or whose thyroid function is impaired. Before the war in Ukraine, it was inexpensive and highly available, said Dr. Robert McConnell, a physician at the Columbia University Irving Medical Center and expert in radiation-caused thyroid disease, which he has studied in Ukraine since the aftermath of the 1986 Chernobyl nuclear power plant disaster.
It was also widely needed. For the past 25 years, working with the National Cancer Institute and in partnership with the government of Ukraine, McConnell and his colleagues have studied a cohort of 12,000 people who were under the age of 18 when they were exposed to the effects of Chernobyl’s fallout.
Even among their cohort, approximately 300 people had thyroidectomies, about half of them due to cancer. Even decades later, “we’re finding an excess number of cancers, beyond what you would expect from screening. And the cancers have a unique genetic signature…they are radiation induced,” McConnell said.
Many of the people affected by thyroid disease rely on the medication levothyroxine.
According to McConnell, a pharmaceutical manufacturer of the medication was destroyed by artillery fire. Ukrainians “haven’t had any levothyroxine available locally since the second week of the war,” he said. “Now we have these young adults who were exposed to Chernobyl, and they’re without thyroid hormone.”
In addition, there have been reports of people wanting levothyroxine to protect them from the effects of radiation caused by a nuclear attack.
However, it works differently than something preventative like potassium iodide, said Alycia Clark, Direct Relief’s director of pharmacy and clinical affairs. “As a hormone replacement, it’s really meant for people who already have experienced impaired thyroid function,” she said.
Going without the medication is dangerous. McConnell explained that withdrawal symptoms – including low blood pressure, extreme fatigue, muscle cramps, depression, and sensitivity to cold (“and it’s winter,” he pointed out) – begin after about two weeks without treatment. After three months without it, people’s conditions can become life-threatening.
Complicating matters is the fact that the subjects McConnell and his colleagues are tracking have scattered because of the war. “It’s just a big, big question mark. We don’t know how many have gotten out,” he said. “It’s heartbreaking and sickening.”
Even before the war began, Direct Relief had a shipment containing levothyroxine packed and ready for shipment to Ukraine. “We almost always have levothyroxine in our inventory,” Clark said.
In the days immediately after the invasion, “the first requests were [for] all the wound care and trauma,” she said. But as the war has dragged on, the drugs required for routine care – including levothyroxine – are increasingly requested.
Direct Relief has shipped more than 14 million defined daily doses – totaling above 30,000 pounds – of levothyroxine to Ukraine’s Ministry of Health at their request, and to Charity Fund Modern Village and Town, for distribution to health facilities serving people affected by the conflict.
