Maite Inchaussandague

IR I-11AP
Jan. 21, 2020
Hashimoto’s Disease: Compilled Annotations
Brito Sosa, Germán, et al. “Cáncer Diferenciado de Tiroides y Tiroiditis de Hashimoto
En El Instituto Nacional de Oncología y Radiobiología (2006 - 2010).” Revista Cubana
de Cirugía, vol. 54, no. 3, Sept. 2015, pp. 0–0.
This article, from the Surgery Cuban Magazine, describes the behavior of thyroid cancer
in patients with Hashimoto's thyroiditis. In order to do this, a retrospective, longitudinal,
descriptive and observational study of 71 patients suffering Hashimoto's thyroiditis was made,
and they were treated at the National Institute of Oncology and Radiobiology during 2006
through 2010. According to their results, Hashimoto's thyroiditis associated with thyroid nodules
was more frequent in 50-59 years group and women were the most affected. Twelve (16.9 %) out
of 71 patients who formed the universe of study were diagnosed with papillary thyroid
carcinoma, all of them women. The incidence of thyroid cancer increased with age. Transient
hypoparathyroidism (the state of decreased secretion or activity of parathyroid hormone) was the
most important postoperative complication.
In closing, based on the results, the longer evolution of Hashimoto's thyroiditis, the
greater probability of occuring thyroid nodules, with the risk of developing thyroid cancer. The
management of nodular Hashimoto's thyroiditis is the same as that of thyroid nodule without
thyroiditis. For their assessment, the main methods are fine needle aspiration biopsy,
echography, freezing biopsy, prognostic and risk factors, and paraffin biopsy. Fine needle
aspiration biopsy is very important in the screening of a thyroid nodule. These are various types
of diagnosis that are relevant for the research, since it is important to know the efficiency of each
of them after identifying the Hashimoto’s disease symptoms.

González Rodríguez, Rebeca Ivonne, et al. “TIROIDITIS DE HASHIMOTO EN UNA

ADOLESCENTE CON OBESIDAD.” Revista Científica Ciencia Médica, vol. 22, no. 1,
2019, pp. 62–67.

This article, from a Scientific Journal of Medical Science, deals with a Hashimoto’s
thyroiditis case in a teenager with obesity. The authors describe a female patient of 14 years oíd,
refers constipation, oligomenorrhea and headache. She had dorsal hump, goiter, acanthosis
nigricans, geno valgus (deformity in the alignment of the knees), dry skin, Body Mass Index
(BMI) 38,5 kg/m2 (> Percentile 97), body fat 46,9% (bioelectrical impedance analysis), waist
circumference> Percentile 90, blood pressure levels (95/60 mmHg) in normal values for age and
sex. Hashimoto's thyroiditis was diagnosed by detecting primary hypothyroidism coupled with
elevation of anti TPO. She had an ultrasound of the neck with increased thyroid lobes without
calcification or vascularity. The patient started consuming levothyroxine (thyroid hormone) 100
μg / day, 6 months of management: weight loss of 5,5 kg, BMI 36,7 kg/m2, remission of
symptoms, with improvement in thyroid function tests. In addition, the patient had a history of
being a pregnancy product complicated by preeclampsia, she did not receive breastfeeding, early
ablation, and was sedentary, with a weight increase since childhood.

1
 In patients with Hashimoto's Thyroiditis (HT), an intentional search for autoimmune
pathology should be performed. It is considered that the finding of autoantibodies is sufficient
evidence for the diagnosis, since it has been correlated with lymphocytic infiltration of the gland.
Likewise, alterations in thyroid function occur in 20% of patients with severe obesity, it is
considered that the increase in TSH is part of an adaptive response since there are receptors to it
in adipose tissue. These alterations can also be explained by neuroendocrine dysfunction,
peripheral hormonal resistance, increase in deiodinase activity, increase in pro-inflammatory
cytokines (characteristic of obesity) that inhibit the sodium / iodine transporter compensating for
elevated TSH6. This case serves as evidence for this condition, since the diagnosis depends
specifically on each patients physical conditions, and stage of Hashimoto’s disease, and more
importantly, on the level of hypothyroidism.

Hashimoto’s Disease | NIDDK. https://www.niddk.nih.gov/health-information/endocrine-

diseases/hashimotos-disease. Accessed 18 Nov. 2019.

This website provides information about endocrine diseases, in which Hashimoto’s

disease (HD) is included. It principally focuses on the definition of the HD, how common it is in
the U.S., and who is more likely to develop this disease. Moreover, it mentions other health
problems linked to HD, and related to hypothyroidism, which are relevant to the cause of
creating awareness about the disease in order to avoid other long-term dysfunctions or diseases,
caused by HD. The article also describes HD during pregnancy, and how it can highly affect the
mother and the baby’s metabolism, which serves as another reason to take thyroid medicine and
treat the disease before the patient decides to have a baby. Lastly, the author develops more
about the disease itself, its symptoms, causes, diagnostician, and treatment. Eating habits fall into
the treatment, and also can be a way to prevent developing the disease over time.
This article provided the researcher with information to address at the background of the
outline since the audience needs to know more about the disease (causes, symptoms, long-term
effects, treatment) in order to understand the reasons why it is so important to be aware of its
symptoms and to take action quickly in case of having them. This is to avoid having a
dysfunctional metabolism, which affects the immune system and can cause many other
autoimmune diseases, such as celiac and diabetic disease. In addition, this source of information
shows a graph of the thyroid gland’s shape of a patient with Hashimoto’s disease and gives an
idea of its behavior in a patient that has Hashimoto’s disease.

Hashimoto Thyroiditis: Practice Essentials, Background, Etiology. Nov.

2019, https://emedicine.medscape.com/article/120937-overview#a5.
This article introduces with the epidemiology: the occurrence in the U.S., the
international occurrence, sex- and age-related demographics. It follows with the prognosis,
therapeutic complications, and patient education. Moreover, it provides a background history of
the disease, its symptoms, the physical examination, and some diagnostic considerations. In
addition, the website where the researcher found this article, Medscape, has a section where
people can ask questions about the topic, and it has a personal experience regarding their
education about thyroid diseases.
The researcher found this article very useful for my research outline because it provides
more background about Hashimoto’s disease in the U.S., which is one of the countries that the
researcher is analyzing in terms of patients. In order to make a difference in their medical

2
education, it is first needed to know what percentage of the population is affected by this disease,
and which are the factors that activate the gene that develops it, affecting the whole body’s
system. The researcher is planning to include this information in my outline, and research paper
to support my main thesis, and to promote thyroid disease awareness and education.

Hayes Dorado, Juan Pablo, and Walter Montero Justiniano. “Tiroiditis de Hashimoto En Niños y
Adolescentes Con Bocio.” Revista de La Sociedad Boliviana de Pediatría, vol. 45, no. 2,
Apr. 2006, pp. 95–97.
This article analyzes the diagnostic evaluation and treatment applied in pediatric patients
with goitre, that is, with the inflamed thyroid gland, due to Hashimoto's thyroiditis. The
hypothesis, in detail, of the doctor who wrote this article is that Hashimoto's thyroiditis is the
frequent cause of goitre in pediatric patients; It usually affects puberes, euthyroid and female. To
verify it, some patients under 15 years of age attended in the pediatric endocrinology office of
the "Santa Cruz Hospital" in Bolivia were studied, with the diagnosis of goiter (inflamed thyroid
gland), during the period of three years. The variables investigated were age, sex, and family
history of thyroidepathies, goiter grade, thyroid ultrasound findings, serum levels of TSH, T4L,
T3, T4 and anti TPO (thyroid hormones). In addition, patients who did not complete clinical
laboratory follow-up were excluded. Regarding experimentation, 86 patients with goitre were
treated, in total. After analyzing their clinical follow-up, 19 patients were excluded. 91% of the
patients were 12 to 14 years old; 76% were female and 87% euthyroid; 13% hypothyroid
levothyroxine therapy was initiated. As a result, Hashimoto's thyroiditis was diagnosed in 36%
of patients (with anti-positive TPO antibodies and ultrasound findings typical of the disease).
In conclusion, this article was useful for research on Hashimoto's disease because it
supports a fact of the thyroid and its inflamed form, in most pediatric patients, the youngest, as a
result of Hashimoto's disease. On top of this, the document contains a series of statistics that
serve as evidence to argue this condition. It should be noted that, according to the article, the
doctors involved in this experiment are pediatricians and specialize in patients under 18,
therefore, the article has some credibility and professionalism.

Luis Román, D. de, et al. “Hipotiroidismo: Implicaciones Clínicas y Económicas En Un

Área de Salud.” Anales de Medicina Interna, vol. 20, no. 3, Mar. 2003, pp. 25–31.

This medical article analyzes the clinical, biochemical and epidemiological

characteristics in patients with hypothyroidism, the substitute dose and the annual direct costs, in
a health area located in Madrid, Spain. Seventy five patients attended in a health area were
included in the review. Furthermore, data was divided in epidemiological, biochemical, clinics
and economics. More in detail, 94.7% of the patients were females and 5.3% males, with an
average age of 52.07+16.5 years. The results show that the most frequent disease was Thyroiditis
of Hashimoto 48% and atrophic thyroiditis 46.6%. A 58,7% of patients had goiter (inflamed
thyroid), only envident 2.6%. In terms of the medication, the average dose of T4 (thyroid
hormone) was 81+53.5 mg/day. The average number of visits was 2.67+1.08. The highest cost
was due to specialists visit 160+65 euros with a total average cost of 212.9+81.5 euros.
Hashimoto’s disease, with a higher number of visits and costs.
In conclusion, this article shows that the most prevalent disease is autoimmune (T
Hashimoto and Atrophic thyroiditis) with higher levels of TPO (enzyme expressed mainly in the
thyroid where it is secreted into colloid) in Hashimoto. The authors highlight that the total cost is

3
higher in Thyroiditis of Hashimoto, compared to the Atrophic thyroiditis, which makes it harder
for the patients to treat it, especially if it is not during an early stage. The statistics provided were
experimented by the Unidad de Endocrinología y Nutrición Clínica, the Unidad de Apoyo a la
Investigación, the Hospital del Río Hortega, the Instituto de Endocrinología y Nutrición, and
Facultad de Medicina, all institutions located in Spain.

Piraino N, Patricia, et al. “Tiroiditis Crónica de Hashimoto: Serie Clínica.” Revista Médica de
Chile, vol. 138, no. 7, July 2010, pp. 827–31. SciELO, doi:10.4067/S0034-
98872010000700006.

This article of investigation supports the claim of the Chronic Hashimoto Thyroiditis
(CHT) as the main cause of hypothyroidism. The aim of the authors is to report a series of
patients with CHT. In order to do this, a Retrospective analysis of a series of 27 men aged 38 ±
14 years and 201 women aged 37 ± 16 years, were evaluated in the private offices of two of the
authors. The results indicated that 50% of patients only had nonspecific symptoms at the moment
of consultation, 50% had a family history of thyroid diseases and only 21% of women had a
previous history of goiter. Furthermore, 81% percent of patients had clinical or subclinical
hypothyroidism, 62% had both antithyroglobulin and antithyroid peroxidase positive antibodies
and 13% had both antibodies negative. Only 1.4% of patients had a normal thyroid ultrasound
examination. During the analysis, the patients were treated with levothyroxine (thyroid hormones
in medication) at a mean dosage of 75 µg/day and 53% achieved an adequate TSH level. It is
important to know that six of ten patients operated due to nodules had a papillary carcinoma,
because that affected the results, since the diagnosis was faster than the other patients.
In conclusion, CHT (Chronic Hashimoto Thyroiditis) should be sought in the general
population, especially those with a family history of thyroid disease. Thyroid ultrasound is
seldom normal in patients with CHT. Thyroid substitution should be monitored periodically to
achieve adequate TSH levels. This types of diagnosis are necessary for the determination of the
thyroid treatment, and this medical article provides information and statistics of many patients
who were diagnosed of CHT, some earlier and some later with an advanced disease, in Santiago
de Chile. In addition, the BioMer, (Centro de Biomedicina y Reproducción), the Universidad de
los Andes y Clínica Santa María, and the Escuela de Salud Pública Universidad de Chile y
Sociedad Chilena de Endocrinología y Diabetes, are all medical institutions that are specialized
in endocrinology, and provided a complete analysis of the CHT diagnosis, which is definitely
useful for the research paper about how important is to know the symptoms and run the exams to
identify the disease as soon as possible, and treat the thyroid in an early stage.

Quesada, Marelys Yanes, et al. “Hipotiroidismo Subclínico, Ni Tan Asintomático, Ni Tan

Inofensivo.” Revista Cubana de Endocrinología, vol. 20, no. 2, Apr. 2009, pp. 0–0.

This medical magazine article develops on subclinical hypothyroidism, which is the

condition defined by the raise of thyroid-stimulating hormone in the presence of normal thyroid
hormone secretion (T3 and T4) for reference rank. Its clinical manifestations are not so nulls as
defines the subclinical term. If an appropriate questioning and clinical examination is made, it is
possible to find alterations in many systems and organs harming the quality of life of patients
affected and to increase its morbidity and mortality. During pregnancy this entity acquires a
special attention due to repercussions on fetal development alteration. In elderly patients is

4
essential its diagnosis due to entity prevalence increase on this group and the repercussion on
quality of life. The aim of the present paper is to review the clinical alterations that may be
present in subclinical hypothyroidism, as well as in special situations of life (pregnancy and
senescence).
To conclude, this paper emphasizes on the clinical manifestations presented in the
different organs and systems affect the quality of life and increase the morbidity and mortality of
the affected patients. They can precede biochemical alterations in months or years, and only a
good interrogation or a physical examination is able to put it in evidence. In this paper, the
authors intend to review the main elements of the clinical picture and physical examination
findings that can be found in patients with HS, as well as their impact on special life situations
(pregnancy and old age). In addition, they have the purpose of alerting doctors to actively seek
the alterations that occur in these patients, including latent, in order to treat them and improve
their quality of life.

Resende de Paiva, Christina, et al., “Association between Hashimoto’s Thyroiditis and

Thyroid Cancer in 64,628 Patients.” Frontiers in Oncology, vol. 7, Apr. 2017,
doi:10.3389/fonc.2017.00053.
This medical article provides a background of the incidence of thyroid cancer (TC),
which is increasing although explanatory causes are lacking. A link between cancer and
inflammation is well documented but unclear for autoimmune thyroid diseases and TC. The
author informs about the aim of his team to systematically review the association between
Hashimoto’s thyroiditis (HT) and papillary, follicular, medullary, anaplastic thyroid carcinoma,
and thyroid lymphoma (TL). After mentioning their studies on several patients, he concluded and
reported an association between HT and PTC and between HT and TL. However, no association
was found between HT and follicular, medullary, or anaplastic thyroid cancer.
When thyroid cancers are removed at the time of surgery, the cellular changes of
Hashimoto’s thyroiditis are commonly seen surrounding the thyroid cancer.  To better
understand and validate the association between HT and TC and to exclude biases, prospective
studies involving large cohorts and long-term follow-up are needed. Furthermore, uniform
diagnostic criteria would strengthen future research.

Yanes Quesada, Marelys, et al. “Caracterización Clínica y Funcional En Pacientes Con

Diagnóstico Inicial de Tiroiditis de Hashimoto En El Año 2007.” Revista Cubana de
Endocrinología, vol. 19, no. 2, Aug. 2008, pp. 0–0.
This medical magazine article describes Hashimoto's thyroiditis as an autoimmune
thyroid affection of slow evolution and as the first cause of hypothyroidism with goiter in zones
with an adequate ingestion of iodine. The purpose of this document is to identify the clinical
characteristics (age, sex, family pathological history of thyroid disease and presence of goiter), as
well as the state of thyroid function at the moment of diagnosing Hashimoto's thyroiditis. For the
purpose, a descriptive cross-sectional study was conducted in 41 patients with initial diagnosis of
Hashimoto's thyroiditis during 2007. They were surveyed and they underwent a thyroid medical
examination. The thyroid stimulating hormone dosage and the total thyroxine were determined.
The data was analyzed by using the percentage method, and they were exposed in tables. In total,
a predominance of the female sex (78 %) was observed. According to age and sex, the most
frequent group was the group of females aged 50-59 with 29.26 %. 60.97 % of the patients had

5
family pathological history of thyroid disease. All the patients presented goiter and the grade II
was the most common, with 60.97 %. 58.53 % of the patients were functionally euthyroideal.
In conclusion, the results show that Hashimoto's thyroiditis is more frequent among
females and in the fifth decade of life. The presence of personal pathological history was very
usual and all the patients had goiter on the diagnosis. The grade II goiter was the most observed.
Most of the patients had a normal thyroid function, followed by subclinical hypothyroidism and
clinical hypothyroidism. Furthermore, according to the article, all of the authors have a Degree in
Integral General Medicine and Endocrinology, and studied in La Habana, Cuba.

Zaletel, Katja, and Simona Gaberšček. “Hashimoto’s Thyroiditis: From Genes to the
Disease.” Current Genomics, vol. 12, no. 8, Dec. 2011, pp. 576–88,
doi:10.2174/138920211798120763.
This article provides detailed information about Hashimoto’s thyroiditis (HT), as the
most prevalent autoimmune thyroid disorder. The author introduces with the definition of the
disease and utilizes the proper medical terminology of the thyroid components and hormones.
Firstly, the document provides a description about the genetic susceptibility of the disease, which
includes epidemiological evidence and susceptibility genes. Secondly, it explains the role of
female sex and reproduction, the pregnancy and postpartum period, and the fetal micro
chimerism of people who suffer from this thyroid disease. It also expands on environmental
triggers of the disease, such as iodine intake, drugs, infections, and chemicals. Lastly, the
protection and development against thyroid autoimmunity, and the thyroid destruction are
mentioned at the end of the document.
HT is one of the most prevalent autoimmune diseases provoked in genetically susceptible
individuals by several triggers, including female sex, immune changes after delivery, fetal micro
chimerism, iodine intake, and other environmental factors. Multiple susceptibility genes may be
involved in the disease development, some of which are also common for other autoimmune
diseases, while others are specific for thyroid autoimmunity. This article helped the researcher to
learn more about the different genes that influence Hashimoto's thyroiditis.

Dr. Restrepo, Gustavo. Personal interview. November 20 2019.

In this interview, the researcher asked multiple questions to Dr. Gustavo Restrepo, a
general surgeon who has operated the thyroid gland of many patients throughout his career, and
his knowledge about thyroid diseases are directly related with his experience operating thyroids
affected by Hashimoto’s disease, but more commonly, by thyroid cancer. At the beginning he
specified that he mostly focuses on the abdominal organs and on the thyroid gland. He was born
in Colombia and studied in Medellin. His medical career lasted six years, and then he came to
the United States when he was 25 years old in order to do his residency. Furthermore, he talked
about medicine as a universal career, and emphasized the fact that procedures do not greatly
differ from each other. However, regarding to the hospitals, he believes that the hospitals in the
U.S. are in better conditions because it is has a more developed economy, whereas in Colombia
the state does not have enough resources to invest in the advanced tools, technology, and to

6
maintain their hospital buildings as neat. Dr. Gustavo Restrepo has worked in ten different
hospitals throughout his career, including Province Hospital (Washington D.C.), Washington A.
Hospital (Montgomery County), Holy Cross (Montgomery County), Shady Grove Hospital
(Montgomery County), Doctors Hospital (Prince George’s County). Regarding thyroid surgery,
he said that most of the patients he operated where previously diagnosed with thyroid cancer, and
that the most common types are papillary and follicular cancer. As cancer grows the patient can
have a lump that can be felt through the skin on your neck, it can change their voice, they can
have difficulty swallowing, and they usually suffer pain in their neck and throat. It can be
possible that a patient has had Hashimoto’s disease and thyroid cancer, but he has never treated a
patient because of Hashimoto's disease, because the thyroid does not get destroyed because of
hypothyroidism but most definitely because of hyperthyroidism. When the pituitary gland forces
the thyroid to produce more hormones than what the body needs, the thyroid overstressed and
can hurt itself, since Hashimoto’s disease is autoimmune.
In conclusion, there is a possibility that patients with Hashimoto’s disease develop
thyroid cancer. However, the patients that get a thyroidectomy, which is a procedure to remove
all or part of the thyroid gland, are the ones who suffered hyperthyroidism. Given the possibility
that Hashimoto's thyroiditis can start with hyperthyroidism and develop into hypothyroidism
over time, a patient with this condition could need surgery if the thyroid was left very damaged
after over demanding itself to produce an excess of thyroid hormone (T3 and T4 hormone). Since
every surgery is an invasion of the body in every case, it is crucial to identify the disease to
prevent the growth of a malignant thyroid nodule, and develop thyroid cancer.

Dr. Passerieu, Mariano. Personal interview. 18 December 2019.

In this interview the researcher asked a series of questions to Dr. Mariano Passerieu, a
professional endocrinologist who has been treating patients for more than 20 years. The
interview was conducted through Skype, and the information he provided was in Spanish. He
studied medicine in Buenos Aires, Argentina for 6 years. Furthermore, he said that the treatment
depends on which thyroid disease and on its stage of development, but the medicine in case of
suffering hypothyroidism, one of the direct consequences of Hashimoto’s disease (HD), is called
levothyroxine. This is a manufactured form of the thyroid hormone thyroxine, and it is used to
replace a hormone normally produced by the thyroid gland to regulate the body's energy and
metabolism. Levothyroxine is only given when the patient’s thyroid does not produce enough of
this hormone on its own (hypothyroidism). After explaining the use of levothyroxine, the
researcher asked about the side or secondary effects of this medicine, and he responded that
usually the patients get used to the medicine in a short period of time. In addition, he suggested
that lab and medical tests should be done while the patient is taking the medication.
To close up, Dr. Passerieu stated that if a patient misses a dose, he/she should take it as
soon as you remember; if it is near the time of the next dose, the patient should skip the missed
dose. In addition, he recommended taking your next dose at the regular time so that the patient
establishes it as part of his/her routine and it is easier to remember. This information is very
relevant to the research because the thyroid hormone replacement is needed for every patient
with HD. Usually, a patient suffers from Hasimoto’s disease and hypothyroidism has to take
levothyroxine for the rest of his/her life, since the disease gets worse over time, and the thyroid is
not able to produce enough hormones for the body on a daily basis.

7
 The Electoral College

Board, The Editorial. “Opinion | Fix the Electoral College — Or Scrap It.” The New York Times,
30 Aug. 2019, https://www.nytimes.com/2019/08/30/opinion/electoral-college.html.

The New York Times is a very popular newspaper that was originated in the U.S., has
gained credibility over the last few years. “Fix the Electoral College — Or Scrap It”, by the
Editorial Board, is an opinion article with regards to the Electoral College, the system system
that is used in the United States in presidential elections. The author demonstrates his point of
view and emphasized on how dysfunctional the American system of electing the president is,
since it allows “electors” (the members of the Electoral College) to vote for whomever they
want, rather than the candidate they were pledged to support. Evidence is addressed throughout
the article to demonstrate that The College has survived not because it makes sense, but because
one party or the other has believed it gives them an advantage. According to the author, that may
be smart politics, but it’s terrible for a democracy.
This article focuses on the flaws of the Electoral College in the U.S. from a political point
of view. It also includes several examples of the past elections and their results to support the
author’s thesis. It concludes with the idea that the Electoral College is no longer beneficial for
most of the people in a democracy.

Cooper, Matthew. “How to Fix the Electoral College System; The current system ensures
most states are ignored while a few swing states hoard the attention. “Newsweek, 2 Dec.
2016. Gale OneFile: High School Edition,
https://link.gale.com/apps/doc/A471881278/STOM?
u=clar33415&sid=STOM&xid=686b5499. Accessed 18 Sept. 2019.

This newspaper article addresses some important questions that most American citizens
ask themselves about the Electoral College in the United States: “Why have a system that
ensures most states are buried with attention from the candidates? Should a minority of voters
get to decide who becomes president? And is there any way to fix this system short of a
constitutional amendment?”. Matthew Copper discusses the weaknesses of the Electoral College
in the United States throughout time. Some of his claims include: that the electors are almost
always party hacks and former elected officials, and not some independent body of wise souls
solemnly weighing whether to ratify the people’s choice; and instead of ensuring a nationwide
race, the Electoral College creates an immoral focus on swing states, such as Nevada or Iowa. In
consequence, the article proposes multiple ways to “fix” the voting system, being aware that
most Americans think the popular vote should pick the president. According to the author, two
ideas that could make the system better are, the setting up of the Electoral College by the
Constitution, leaving it to the states to decide how to apportion their electoral votes; or the
National Popular Vote Interstate Compact, an agreement among the states that will give all of
their electoral votes to the winner of the national popular vote.
To conclude, this article provides useful information about the Electoral College and the
most common claims that are made by American citizens nowadays, asking for a more efficient
and fairer voting system. Instead of the candidates interested over a few winner-take-all swing
states, they would have to account for more of the country. In context, the Popular Vote system
can be the solution to “fix” the Electoral College in the United States.

8
 Edwards, George C, Why the Electoral College Is Bad for America, III. New Haven, CT
and London: Yale University Press, 2004. Pages 5-8.

This excerpt from the book discusses Donald Trump’s election to the presidency, in
2016, as one of the greatest surprises in American political history, similar to Harry Truman’s
famous upset of Thomas Dewey in 1948. Because Hillary Clinton led in the public opinion polls
throughout the campaign, few political pundits expected a Trump victory. Although he waged a
much less elaborate and expensive campaign than his opponent, ran under the banner of a more
divided party, lost all the formal presidential debates, and was less popular and rated by voters as
more unqualified for office than Clinton, Trump prevailed. Therefore, many researchers doubt
about the efficiency of the Electoral College. According to the author, there are multiple
questions regarding to the attention of small states, federalism, and the winner-take-all system as
critical for the two-party system, in terms of the political influence of the voting system. In
addition, one of the first pages provides a table that represents the campaign stops in states
between the nominating convention for each candidate and Election Day (last presidential
elections). It is very useful to compare the importance and power of each state in the presidential
elections.
In conclusion, the texts that I critically read from this book provide detailed information
of the last presidential elections, and statistics of the Republican and Democratic votes in the
country. The purpose of the book is to join the issue, to focus directly and systematically on the
core questions surrounding the electoral college and assess whether it warrants a role in
American democracy. These issues addressed are related to my research project, since a lot of
the questions I had on the Electoral College are answered in detail throughout the documents on
the book.

Electoral College | US News. https://www.usnews.com/topics/subjects/electoral_college.

Accessed 3 Oct. 2019.

U.S. News is an online source that provides information about several topics, and areas of
interest for a large audience. It is specially directed to American citizens who read articles about
our society nowadays. I found an article through this source, titled “Sen. Elizabeth Warren Calls
to Abolish the Electoral College”, that explains the new reform to abolish the Electoral College
in the United States. According to the text, this project is supported by Senator Elizabeth Warren,
as well as the Indiana major, Pete Buttigieg. The reform is illustrated throughout the article, and
contains the main statement that the Senator made during a CNN town hall in Jackson, Miss.
This article discusses the importance of the reform to abolish the Electoral College in the
United States, which is supported by many representatives that have the purpose of supporting
our democracy and the voting rights of the people. Moreover, the popular vote is a potential
option according to a lot of people who are fighting for it, to be applied as the voting system in
the country. It is important to understand the main advantages and disadvantages of the Electoral
College in order to compare it to the Popular Vote system. This text provides a lot of information
about it, and many reasons for the U.S. Electoral College to be finally abolished, which improves
my research by providing evidence, and exemplary people, to support my thesis on the
abolishment of the Electoral College.

9
 Pope, Diana, The Best Arguments Against the Electoral College | Fresh U.
https://freshu.io//diana-pope/the-best-arguments-against-the-electoral-college. Accessed
30 Sept. 2019.

This newspaper article explains the Electoral College system and its precedent history
since it was first applied in the United States. The author mainly states that many Americans are
now calling for the disintegration of the Electoral College and are urging Congress to abolish this
historic system. Therefore, Diana Pope provides some crucial arguments that have arisen against
the establishment of the Electoral College. The arguments described are: The Electoral College
acts against democracy; the Electoral College sets up a disparity in representation; electors are
unfairly chosen by their states; election campaigns ignore a large portion of the country; voters
would believe their decision matters.
In closing, this article explains and analyzes the five main arguments against the Electoral
College. This explanation is used as evidence and claims in order to abolish the actual voting
system. According to the author, without the Electoral College, every popular vote would make a
difference in the results of the presidential elections. Under a system of direct election, every
vote would be equally important, and voters would believe they could play a crucial role in
American democracy.

“The Argentine Election Rulebook: A Guide to Understand What’s Coming.” The Essential, 4
July 2019, https://gettheessential.com/politics/2019/07/04/argentina-election-voting-
rules-primaries-runoff.

The Essential is a premium subscription-based news platform that brings you high quality
journalism and in-depth coverage in English about the changing face of Argentina’s politics and
economy. In this article, named “The Argentine election rulebook: a guide to understand what’s
coming” deals with Argentina’s voting system. In other words, it provides a handy summary of
the 2019 Argentine election rulebook and its implications. It discusses what positions are up for a
vote, how the winners are decided, how many rounds of voting we’ll end up seeing and all the
strategies built around Argentina’s voting laws. The author emphasizes on the convoluted nature
of Argentine politics that can make them hard to follow for any outsider. One thing that surely
helps is to know the rules, but they are hardly ever spelled out anywhere even if everyone likes
to play to their limit. In consequence, it is important to understand the popular vote system and
how it is applied to many countries in the world, such as Argentina in South America.
The article is mainly composed by rules and facts previously established by the Argentine
government. Each explanation comes with an analysis from the people’s perspective, and the
impact it has on them as citizens. It is crucial to understand the popular vote system in order to
form an opinion and be able to see the several advantages it has, compared to other electoral
systems executed in other countries in the world.

York, Byron, “The Old College: How we pick the prez”, National Review, 4, 4 Dec. 2000. Gale
OneFile: High School Edition, https://link.gale.com/apps/doc/A67004580/STOM?
u=clar33415&sid=STOM&xid=e63e7754. Accessed 18 Sept. 2019.

Gale OneFile is an electronic library that provides access to scholarly journals and trade
publications, essential for information professionals and other knowledge workers. The database
offers coverage of topics including information about the political system in the U.S. and other

10
countries. I searched for articles related to the U.S. Electoral College and found an extensive
article titled “The Old College: How we pick the prez”. This article explains the differences
between the Electoral College and the Popular Voting system. It also provides many claims and
reasons to abolish the Electoral college, and give more voting power to the people in every state.
According to Byron York, some weaknesses/disadvantages of the Electoral College include the
‘battleground states’, the candidates’ advertising strategy (state-based system), the national
networks division, the selection of political issues, and the differentiation between the two
political parties (Democratic and Republican).
In conclusion, this article discusses the impact of the Electoral College in the United
States, and the importance and advantages that the Popular Vote system would have in our
society if applied in the future. Each paragraph explains at least one claim supported by an
important piece of evidence that supports the main thesis of the author: ‘I strongly believe that in
a democracy we should respect the will of the people, and to me that means it’s time to do away
with the Electoral College’, Hillary Rodham Clinton.

11