Ive discussed various options for patients post-thyroidectomy in this post here. Therefore, signalling effects linger on even after the T3 is no longer bound to the receptor and is depleted from blood. Drug cravings. During withdrawal from thyroid hormone, to reduce symptoms of hypothyroidism, your doctor may prescribe a short-acting thyroid hormone called Cytomel (T3) for a few weeks. Your body then becomes reliant upon the medication that you are putting into your body each and every day. Thyroid Patients Canada is a registered federal not-for-profit organization. As shown below, the Cmax T3 level achieved after a dose is absorbed is extremely transient. The last thing you want to have happened when you alter your medication is that you feel worse. Another surprisingly effective strategy for improving your thyroid is through the use of targeted supplements. Ive discussed, at length, what is included in this panel, and you can find more information in this post. Liothyronine is a manufactured form of the thyroid hormone triiodothyronine (T 3). Number of Cytomel and Withdrawal syndrome reports submitted per year: In most cases, discontinuing your thyroid medication (abruptly or otherwise) is not a wise decision. In this post, I present some graphs and half-life calculations for T3 clearance rate, discussing the various factors that make clearance faster or slower. Cytomel causes an increase in the force of contraction and an increase in the heart rate (9). To alleviate symptoms of hypothyroidism, liothyronine (Cytomel, 25 mg twice daily) is administered for the first 4 weeks of the withdrawal period but discontinued during the 2 weeks before the scan. Cytomel T3 have similar effects to cannabis - the same types of psychoactive effects but also with the same effects on different parts of the body. If you feel like you are stuck with your current thyroid medication and arent sure what to do then this is the section for you. Fliers, Eric, Antonio C Bianco, Lies Langouche, and Anita Boelen. Just realize this is something you should be doing. Published online 2016 Jun 6. doi: 10.4274/mirt.88598;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096624; Accessed June, 2020. A high TSH can stimulate a rise in cortisol, at first. Thyroid Symptoms, Solutions . The T3 remaining by day 8 was buoyed up by T4-T3 conversion: The mean serum T4 values in the athyreotic group were 0.40.1 mcg/dl, indicating that residual T4 was present from previous T4 therapy. And when I say important, thats really an understatement. #2. Learn how your comment data is processed. Lee, Jandee, Mee Jin Yun, Kee Hyun Nam, Woong Youn Chung, Euy-Young Soh, and Cheong Soo Park. cytomel withdrawal symptoms; joaquin niemann sponsors. This represents 1/5 of your total hormone intake in a day When you look at it that way, 5 mcg is not insignificant. Jun 2022 24. spezzatino al sugo con patate in pentola a pressione Facebook; unexpected wedding readings Twitter; mon voisin fume de l'herbe et ca sent chez moi Google+; thomas wright obituary 2021 . Levothyroxine Withdrawal. We are not responsible for the content or availability of linked sites. Cerebral Blood Flow and Glucose Metabolism in Hypothyroidism: A Positron Emission Tomography; The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 8, 1 August 2001, Pages 38643870,https://doi.org/10.1210/jcem.86.8.7749. Insignificant symptoms and unlikely events were often given equal or more weight than significant and likely ones. But its not safe to assume that supplements have the ability to replace thyroid medication. LT3 monotherapy is often taken in several divided doses per day.) Symptoms of low thyroid hormone levels include tiredness, muscle aches, constipation, dry skin, weight gain, slow . How long does it take for the final dose of synthetic LT3 (Liothyronine) hormone to clear from blood, and how much suffering might a withdrawal cause? Abrupt discontinuation of SSRIs that have shorter half-lives, such as paroxetine, may induce withdrawal symptoms, some of which may mimic a recurrence of a depressive episode (eg, tiredness, irritability, severe somatic symptoms). 2022 Genzyme Corporation. However, with this skewed curve, the half life in numbers is very deceptive given the long, low tail. Headaches. But make no mistake, the problem is not necessarily the medication (you probably need thyroid medication), instead, the problem has more to do with dosing, the type of thyroid medication you are taking, etc, This group of people should never make changes to their thyroid medication without physician supervision as it can be very dangerous, This axis is very sensitive and it can take weeks to months for it to come back to normal, Its far better, instead, to try other therapies (which are proven to be effective) with a knowledgeable physician, Biest (Medication) Guide for Menopause: Side Effects, Dosing & More, Pros and Cons of Hormone Pellets: Side Effects & More, The 50 mcg Levothyroxine & Synthroid Medication Hack. This lab panel includes the following tests: TSH, free t3, free t4, reverse T3, thyroid antibodies, and sex hormone-binding globulin. The lines for serum are almost straight. Increased fatigue. Indeed, people often go undiagnosed for decades despite suffering from hypothyroid symptoms. 5mcg 1X D. 1/1/2022. A half life can be misleading when the clearance rate is skewed, as it is in LT3 dosing. If you take lanthanum, take it at least 2 hours before or after liothyronine. After withdrawal, some symptoms do not appear until after the medication has disappeared from circulation, due to the long-term and cumulative nature of thyroid hormone signalling. Cytomel and T3 thyroid hormones have a direct effect on the heart and cardiac tissue. Very few studies measure LT3 withdrawal in both types of patients at the same time on the same laboratory tests. This content is strictly the opinion of Dr. Westin Childs and is for educational and information purposes only. The complete lack of thyroid hormone leads to a condition known as myxedema coma which can lead to death (1). Cytomel T3 is a medication that is used to treat hypothyroidism, a condition in which the body does not produce enough thyroid hormone. Leftover thyroid tissue after surgery and cancer cells that have spread to other parts of the body can quickly grow and become painful after Thyrogen administration. To obtain a high level of TSH, your doctor may choose to temporarily stop your thyroid hormone medication four to six weeks before treatment with radioactive iodine (RAI), or for diagnostic testing. Patients who suddenly stop taking levothyroxine may go into withdrawal and may experience symptoms like debilitating weight loss, panic attacks, fatigue, muscle weakness, and nausea. The only exception is T2, which is available in some over-the-counter supplements. (whole-body scan (WBS) or stimulated thyroglobulin (Stim Tg) blood test). Therefore, the survey was designed so as to make it nearly impossible to come near to the maximum score of 31 for a severely reduced quality of life. Clickherefor full Prescribing Information. headaches and muscle aches. Liothyronine is used to treat hypothyroidism, a condition wherein the thyroid gland does not produce enough thyroid hormone. Use of this site constitutes acceptance of eHealthMe.com's terms of service and privacy policy. If THYROGEN is administered with radioiodine, the combination regimen should not be used in pregnant women. Ive done research and came to find out that bodybuilders c 39K subscribers in the Hypothyroidism community. Is your current physician unwilling to work with you to try something new? It is the second most commonly prescribed T3 thyroid medication for the treatment of hypothyroidism as well as other thyroid-related disorders. MyThyroid.com;http://www.mythyroid.com/radioactiveiodinecancer.html. (WRS) = Widlocher Retardation Scale, Important Safety Information and Indications. Ordering and obtaining all of the thyroid lab tests will help give you information about how well you are absorbing thyroid medication, how well you are utilizing it in your body, how your body is metabolizing/converting it, and so on. (This is not common. Walter, Kimberly N, Elizabeth J Corwin, Jan Ulbrecht, Laurence M Demers, Jeanette M Bennett, Courtney A Whetzel, and Laura Cousino Klein. Please consult with your doctor for a list of contraindications for radioiodine. The next step, which hopefully follows #1, is to take a hard look at which medication you are currently using. It does not take long for T3 to fall to harmful and then to dangerous levels in persons who do not have concurrent T4 supply. Our suffering is often underestimated by scientists and doctors. Its very possible that these patients may have been incorrectly placed on thyroid hormones, to begin with. Erlotinib Hydrochloride and Fungal Sepsis, Amlodipine Besylate and Vitamins drug interaction, Headache (pain in head): 8 people, 25.81%, Drug Administration Error: 5 people, 16.13%, Mobility Decreased (ability to move is reduced): 5 people, 16.13%, Drug Exposure During Pregnancy: 4 people, 12.90%, Malaise (a feeling of general discomfort or uneasiness): 4 people, 12.90%, Headache (pain in head): 5 people, 16.13%, Arthritis (form of joint disorder that involves inflammation of one or more joints): 5 people, 16.13%, Fibromyalgia (a long-term condition which causes pain all over the body): 5 people, 16.13%, Neuropathy Peripheral (surface nerve damage): 5 people, 16.13%. This is an important question for many people who dose LT3. Levothyroxine is used to treat low thyroid hormone levels in your body, called hypothyroidism 2. The exception would be if you are starting a new medication, altering your dose or if you are doing it with physician supervision. sun dried tomato bread recipe jamie oliver; laura englander levin wedding; how a guarded man tests you; red thread spaces llc east hartford, ct The withdrawal symptoms can appear after as few as 6-8 . In order for your body to activate this medication, it must convert it into T3 (through thyroid conversion) and not everyone does this at the same rate. . You can take part in a withdrawal program in: a residential detox unit or in a hospital. In clinical studies, the most common side effects reported were nausea and headache. Clearly, the persons with the least amount of T3 in circulation had the slowest clearance rate, and those with a higher T3 cleared it faster. The main difference between the heart and other tissues when it comes to thyroid hormone is the effects at the cellular level: Can You Get Everything Your Thyroid Needs From Food? This may sound depressing, but it doesnt have to be. Withdrawal can often accompany physical symptoms like nausea, vomiting, and diarrhea. Withdrawing from others. Peripheral Tissue Mechanism for Maintenance of Serum Triiodothyronine Values in a Thyroxine-Deficient State in Man. Journal of Clinical Investigation 73 (2): 57075. nausea. Call1-88-THYROGENto speak with a Case Manager. Thyroid Hormone Resistance: What is it & How to Diagnose it, read more about my own personal health journey, free thyroid downloads, resources, and PDFs here, 3 New Thyroid Support Supplements: Thyro Fuel, Thyro Biotic & Hashimotos Ab Rx. Learn More Integer gravida Elderly: Studies do not show a difference in the safety and effectiveness of Thyrogen between adult patients less than 65 years and those over 65 years of age. The half life can also be deceptive because a single number (an average) or a range do not specify important contextual factors. Are you struggling with getting proper thyroid care? Withdrawal of exogenous l-thyroxine for 6 weeks before the scan allows the protein-bound fraction of the hormone to be exhausted. Most doctors can easily and readily diagnose thyroid dysfunction, but the way that they treat thyroid dysfunction has led to many disgruntled thyroid patients. The problem with stopping your medication (abruptly or otherwise) has to do with how thyroid hormone impacts your body. Cytomel (Liothyronine) received an overall rating of 7 out of 10 stars from 40 reviews. It is based on liothyronine sodium (the active ingredients of Cytomel) and Cytomel (the brand name). Thyrogen should be given to a pregnant woman only if the doctor thinks there is a clear need for it. amc gremlin for sale washington state cytomel withdrawal symptoms. DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. These supplements can be used in conjunction with your existing thyroid medication and with other therapies, which makes them great for layering therapies on top of each other. After withdrawal, some symptoms do not appear until after the medication has disappeared from circulation, due to the long-term and cumulative nature of thyroid hormone signalling. If the patient has no symptoms before treatment (just a low temperature). 1984. Common side effects of Cytomel include: nausea. All rights reserved. Thyroid Hormone Withdrawal (THW) this is used to produce high levels of TSH in patients by stopping thyroid hormone pills and causing short-term hypothyroidism. Some people end up experiencing full blown "rage" at times as well. whether or not you have T4 in bloodstream, and how much T4, that is converting to T3 while the LT3 dose clears from blood. Use in pregnancy and breastfeeding is . Douglas Van Nostrand, M.D., Gary Bloom, and Leonard . June 12, 2022 June 12, 2022 0 Comments June 12, 2022 0 Comments The list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose and manage thyroid disease correctly! Need better symptom control? It has been a common practice for many decades to treat thyroid cancer patients after a total thyroidectomy with either LT4 or LT3 monotherapy, and then completely withdraw thyroid hormone prior to radioioidine (RAI) ablation of any thyroid remnants left behind after surgery. Diet and exercise by themselves are probably not enough to cure your condition (though they may for some) but they will allow you to feel better, help maintains your weight, and improves thyroid function. by. He recently came off the Cytomel and is feeling pretty bad. They were a reflection of the daily morning oral T3 dose because blood samples were drawn daily at 0800-1200 h or 2-4 h after the daily T3 dose.. CYTOMEL has a narrow therapeutic index. In general, a handful of common physical withdrawal symptoms include: 4. Jul 24, 2013 1:11 PM. Have you thought about discontinuing your medication? Stages of Thyroid Cancer . The chances of this happening are slim, but the chances of stopping thyroid medication and feeling better are also slim. Uses. TSH stands for thyroid stimulating hormone because it stimulates the production and release of thyroid hormone from your thyroid gland. shaking/tremors. Those words very good are from the doctors point of view. The management of primary hypothyroidism with Levothyroxine is usually simple, effective and safe, and most patients report improved well-being once they have started treatment. Synthroid is FDA pregnancy category A - it is definitely secure for breastfeeding Synthroid or Levothyroxine in its generic form, is a a commonly used medication to treat Hypothyroidism, an underactive thyroid. We will discuss more about that below (you can skip there if you want to now), but first I want to discuss some basics about how thyroid medication is impacting your body. Triiodothyronine (Cytomel) plus any antidepressant. 1972. Just like levothyroxine, Cytomel (liothyronine) is another synthetic thyroid medication. This can definitely but difficult, but Ive put together some resources to help. If you take Cytomel once daily and notice symptoms of hypothyroidism getting worse as the day progresses, speak to your doctor about the possibility of . Children:Safety and effectiveness in young patients (under the age of 18) have not been established. Whenever possible, its always a great idea to take your health into your own hands, do your own research, and make informed decisions about your body and health. Im not depressed and my daughter is 11 years old. Chest pain, heart palpitations, bloating, fatigue, low energy, dry cough. Nevertheless, the hypothyroidism could have been worse. This typically stems from conditions such as hyperthyroidism or thyroid cancer. Medications like NDT (Armour thyroid and WP thyroid) or Cytomel/liothyronine, contain T3 and can be added to your current thyroid regimen. blurred or double vision. Overall, the survey revealed an average of severe suffering, given that an LT3 withdrawal patient with extremely severe symptoms (but no minor genital symptoms or weight gain or dry skin) may have answered with a score of 20 or less. Levothyroxine helps regulate your metabolism and energy, as it is a replacement for a hormone your thyroid normally produces that does this. Different symptoms and health impacts appear at different points on the way to thyroid hormone depletion. You are now leaving Thyrogen.com and going to a website that is not operated by Sanofi Genzyme. 2019. Experts calculate this period using the half-life of a drug. However medical professionals recognise that a proportion of individuals continue to suffer with symptoms despite . Busnardo, Benedetto, M. E. Girelli, F. Bui, G. P. Zanatta, and M. Cimitan. Cytomel; Descriptions. It is used with or without a radiology test using a form of iodine. If you use this eHealthMe study on publication, please acknowledge it with a citation: study title, URL, accessed date. Arq Bras Endocrinol Metab. Stage 2 (24-72 hours after the last drink): The common symptoms during this stage are high blood pressure . In most cases, its not worth the energy to fight with your Doctor for tests or medications. Finally, the half life is deceptive because some people may mistake that the Cmax of a single dose achieves the maximal effect, and that complete clearance removes all the effects of the medication. In most cases, you will find the answer to that question is no. Withdrawal of thyroid hormone, but especially of LT3 monotherapy, can be severely harmful to ones quality of life in the short term. It is also used to treat goiters and to test for hyperthyroidism (a condition where the thyroid gland produces too much thyroid hormone). Consider cases of HPA suppression from cortisol (which can take 6-12 months to recover)(6) or cases of HPO suppression from birth control medication. Withdrawal syndrome is found among people who take Cytomel, especially for people who are female, 60+ old, have been taking the drug for 2 - 5 years. If you know that you have low T3 or have a problem converting thyroid hormone, then taking a supplement designed for improving T3 conversion is probably ideal. Because when the thyroid hormone levels are high, this gives the signal to your body to run at a very high speed. A person can go for many years without thyroid hormones. The process may take from a couple days to a couple weeks to create Cytomel T3. The chances you of convincing your doctor to do this are slim to none. 52 (72% of range) and my Free T3 283 (only 28% of range.) 2010. It takes much longer for TSH to rise after LT4 withdrawal (Lee et al, 2010). I am a former Doctor of Osteopathic Medicine (no longer practicing) that now focuses on producing the information you see here while also formulating some of the best supplements on the market (in my HUMBLE opinion) :). Dont walk on thin ice. The more thyroid hormone you take, the lower your TSH will go (4). Hey! Patients over 65 years old with large amounts of leftover thyroid tissue after surgery, or with a history of heart disease, should discuss with their physicians the risks and benefits of Thyrogen. Its possible, that through incorrect testing of an isolated TSH test, patients can be placed on thyroid medication inappropriately. If you know that you have gut issues that may be contributing to your Hashimotos, then taking a probiotic may be ideal. 8.4 Pediatric Use. cytomel withdrawal symptoms. It is used to treat conditions such as arthritis, blood / hormone / immune system disorders . This medication comes in tablet form to be taken once daily. Get medical help right away, if you have any of the symptoms listed above. It is often used in hypothyroidism. I felt the thyroxine withdrawal six days after stopping it. Here are 4 ways you can get more help right now: #1. (former Osteopathic Physician). Van Tassell does not quantify the limit of detection in units, but it seems to be 10 ng/dL. I saw the best endo in all of St Louis today, what a waste of time. Sign up to receive 20% off your first order. If your current doctor is unwilling to order these tests then you may need to seek out a second opinion and look for someone who specializes in thyroid care. The less thyroid hormone you have in circulation, the more the body hangs on to it, as verified by Bianchi et al, 1978. Loss of appetite. Elevated Thyroid Stimulating Hormone Is Associated with Elevated Cortisol in Healthy Young Men and Women. Thyroid Research 5 (October): 13. https://doi.org/10.1186/1756-6614-5-13. https://doi.org/10.1089/thy.2009.0187. The withdrawal process affects everyone differently in terms of symptoms and severity. This process is called thyroid hormone withdrawal (THW). Patients should remain hydrated prior to treatment with Thyrogen. The score of 3 was reserved for always, which would not be likely for the LT4 patients on 4 weeks of withdrawal given the slow clearance rate of LT4. Mood swings. #3. Does that mean that you need to suffer from any existing symptoms? Other drugs that have the same active ingredients (e.g. Im considering taking T3 after my cycle because ive put on a little more fat than intended. The Interaction Between Thyroid and Kidney Disease: An Overview of the Evidence. Current Opinion in Endocrinology, Diabetes, and Obesity 23 (5): 40715. I love to write and share what I've learned over the years. We do not provide medical advice. It is created by eHealthMe based on reports of 6,191 people who have side effects when taking Cytomel from the FDA, and is updated regularly. This is a compensatory mechanism by which the body reduces the effect of hypothyroidism on the one hand, and can clear out short term excess on the other hand. I don't say that like I don't believe him . Breastfeeding women should discuss the benefits and risks of Thyrogen with their physician. Since Thyrogen was first approved for use, there have been reports of central nervous system problems such as stroke in young women who have a higher chance of having a stroke, and weakness on one side of the body. You may be prone to anger spells and have a difficult time controlling your anger. Breastfeeding patients:If THYROGEN is administered with radioiodine, the combination regimen should not be used in breastfeeding women. Lastly, and perhaps the most important thing you can do is to try and find a physician or Doctor who is willing and able to help you with your condition. The answer is, not without some extreme suffering. When it releases hormones, it is like pushing the gas pedal. When your doctor asks you to stop your thyroid medication, your hormone level will decrease significantly, and this may lead to signs and symptoms of acute hypothyroidism. It may surprise you that your thyroid is responsible for some very important functions inside your body. Some reports may have incomplete information. The benefit of LT3 withdrawal in comparison to LT4 was that LT3 cut the post-withdrawal suffering time in half (2 weeks) by speeding up the rise of TSH. Anger: Coming off of this medication may make you extremely angry and frustrated. Withdrawal symptoms of suddenly stopping certain antidepressants include anxiety, chills, difficulty sleeping, dizziness, headaches, increased depression symptoms, irritability, muscle aches, nausea, sensations of electric shock, sleepiness, and vivid dreams. Cytomel. My t3 dose was reduced from 20ug to 10ug 6 days ago and today I am in bed feeling really bad. Instead of stopping your medication, there is another approach. Proteins triggered by T3 remain in the body and have their own life cycle beyond T3s clearance. Doctors such as endocrinologists and PCPs may, surprisingly, not be best suited to help you. Scroll. Here are the most recent graphs of LT3 clearance rate over 75 hours in 14 patients post-thyroidectomy after being treated with LT4 alone for 30 days, and terminal elimination was assessed over 11 days. (VanTassell et al, 2019.). MAT-US-2011762-v2.0-05/2022 Last Updated: May 2022, Contact Us Sitemap Legal Notice Cookie policy settings. Get my free thyroid downloads, resources, and PDFs here. Patients with cancer cells near their windpipe, in their central nervous system, or in their lungs may need treatment with a glucocorticoid (a medication to help prevent an increase in the size of the cancer cells before using Thyrogen.). severe headache. Flu like symptoms. To put that in context, thereference rangeof total triiodothyronine (T3) is approximately 80-220 ng/dL in adults. Weakness, lethargy, cold intolerance, paleness, dry skin, coarse hair, and constipation can occur with acute hypothyroidism. I went out of the country with out my prescription for cytomel. Stick to a structured sleep schedule. 1983. Post-acute and protracted withdrawal symptoms from meth can include: 3. If your body is capable of producing less than the amount that you are taking then you will be at an even worse deficit! This means that there are some people (up to 15% of the population based on genetic studies) who simply dont do well on T4-only thyroid medication. People may assume that when they stop taking thyroid medication their bodies will be able to start producing it on their own. Our analysis results are available to researchers, health care professionals, patients (testimonials), and software developers (open API). Never make any assumptions about your body or your thyroid function based on someone elses experience. People with a TBG deficiency had a T3 clearance rate similar to that of thyrotoxic people. The first half of the half life describes a steep crash; the decline past the half-life takes a much longer time. Symptoms that impair complex and demanding tasks may appear long before the half life of the dose if one starts from a position of LT3-dependent euthyroidism (Busnardo et al, 1983) and then progresses all the way to depletion of T3 without any T4 support. When you use supplements make sure that you find very high-quality supplements, and make sure that you are using it for your desired outcome. Endocrine and Metabolic Considerations in Critically Ill Patients. The Lancet. You can use the study as a second opinion to make health care decisions. If possible, offer to help with these tasks so your loved one can focus on healing. (Cytomel), 75 mcg daily." There was only one dose per day. Hashimoto's thyroiditis. 2016 Jun; 25(2): 7984. Not all supplements are created equal and not all thyroid patients will need the exact same supplements. F. Hi, I'm sorry you are having these symptoms. The first step is to get a complete thyroid lab panel. This T4-only thyroid medication may be one of the reasons that you arent feeling well. Even maintaining a thyroid patient with very low-normal FT3 and FT4 can cause myxedema crisis, given enough time (Mallipehdi et al, 2011). LT3 monotherapy is often taken in several divided doses per day.). Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. Thyroid hormones are regulated by the FDA which means that they require a prescription medication. All rights reserved. Withdrawal syndrome (a discontinuation syndrome is a set of symptoms occurred due to discontinuation of substance) is found to be associated with 1,809 drugs and 1,379 conditions by eHealthMe. It is not known whether Thyrogen can appear in human milk. 6,191 people reported to have side effects when taking Cytomel. Pregnant patients:Notify your healthcare provider immediately in the event of a pregnancy. Just realize that some people may feel better when they stop the medication, but the exact reason should be evaluated on the individual level. (in a child or teenager) pain, stiffness, and trouble moving the legs. In addition, Cytomel often needs to be taken multiple times a day since it has a short half-life, resulting in fluctuating levels in the body. However, compensatory mechanisms may only be short term. Simultaneous Measurement of Thyroxine and Triiodothyronine Peripheral Turnover Kinetics in Man. The Journal of Clinical Investigation 51 (3): 47383. The peak clears from blood within a few hours, followed by a very long tail. Clearly, we do not all metabolize or clear T3 at the same rate. sense of detachment from self or body. Fair dealing: See Section 29.1, Canada Copyright Act,https://laws-lois.justice.gc.ca/eng/acts/C-42/page-9.html#h-26, Click to access Fair-dealing-comparison-chart.pdf.

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