Day by day, the population of our country is increasing and the doctor-patient ratio is reducing. It is all the more important that many patients having lifetime diseases should be educated to look after themselves and to contact doctors only when required. This holds true for hypertension, diabetes mellitus and many other common diseases. With future generations becoming smarter, more educated and computer savvy, the patient should be guided by the family physicians about more and more diseases. A very good example is a case of bronchial asthma or epilepsy, where self education is essential. Remember that the income of the family physician will not be affected as long as they start charging consulting fees, whenever they examine or advise a patient.

Similarly, hypothyroidism is a lifelong disease, usually caused due to destruction of thyroid cells by:

1) auto antibodies and 2) in recent times, by the radioactive iodine treatment, given to patients of Graves’ disease. A few patients of hypothyroidism may be exception.

I am highlighting a few points, which can be enlarged upon by the family physician. They are as follows:-

1. When a hypothyroid pregnant woman gives birth to a child, the diagnosis of cretinism should be established in the newborn as early as possible and treatment started.
2. In young children, if the physical and mental growth has to be kept normal, thyroid therapy should be given in accurate doses. Otherwise, the family physician will be blamed by the parents later on.
3. Just as a diabetic is taught to adjust the doses of his medicine by the level of his blood sugar, a hypothyroid patient should get his blood level of TSH and T4 tested every year (may be every 6 months to maximum of 2 years) to make sure that his requirements of thyroid replacement are adequately adjusted.
4. In a young, pregnant woman, often the dose of thyroid needs to be increased to look after the growing foetus. This point is to be stressed upon the family members.
5. Iron capsules prescribed for common illness like anaemia will interact with absorption of thyroxine.
6. Hyperacidity has become more or less universal. Antacids taken along with thyroxine, will interfere with its absorption.
7. Many young women especially during pregnancy and post partum, are prescribed calcium tablets. Calcium taken along with thyroxine, can reduce its absorption.
8. When a female patient attains menopause, often the requirement of thyroid falls. In such a case, the dose should be adjusted by testing the TSH and T4 every 6 months.
9. Finally, during old age, patients of hypothyroidism are more prone to ischaemic heart disease because of high lipids. Vice versa, the incidence of hypothyroidism increases with age. With the result, a family physician can expect 10% of his elderly population to have hypothyroidism (picked up by routine TSH.levels and not by a clinical picture). Thus, a patient who presents with angina pectoris could have hypothyroidism. Remember that these patients can be extremely sensitive to a dose of thyroxine tablet. I have seen three deaths in private practice, which occurred suddenly because of the above situation. Thus there is no hurry to start treating hypothyroidism as the patient can continue to live his life, though subnormally. It is very important to evaluate these patients in detail. Try to persuade such a patient for an interventional procedure in addition to medical treatment for angina before wanting to show off your skill by changing his appearance by giving him thyroxine tablets. The tablets should be given in a very small dose like 50 microgram, especially after angina pectoris is controlled. A known patient of hypothyroidism, when diagnosed as a case of angina pectoris should tell the cardiologist that he has hypothyroidism. Thus angina pectoris associated with hypothyroidism should always be handled as if you are treating a case of unstable angina.