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May 30, 2015

Pakistan must initiate universal screening of newborns for detection of thyroid conditions


May 30, 2015

Pakistan must immediately initiate a national testing service for universal screening of newborn children in order to protect them from the developmental, intellectual, and physical morbidities associated with congenital hypothyroidism.
This was one of the strongest recommendations tabled by leading endocrinologists who had gathered under one roof here Friday in connection with a highly informative public awareness seminar on conditions associated with the working of the thyroid gland. The seminar was organised by the Mir Khalil-ur-Rehman Memorial Society (MKRMS), in collaboration with Pakistan Endocrine Society (PES), to mark the observance of World Thyroid Day, which falls on May 25. The seminar was moderated by Wasif Nagi from MKRMS.
Even though such mandatory screening is recognised worldwide as the most efficacious intervention for treatment of conditions related to the working of the thyroid gland, it continues to be a low-priority in Pakistan, the speakers regretted, urging the media to shake the government out of its complacent mode.
“Thyroid, after diabetes, is the most common ailment that we come across in our practice,” remarked the president of PES Dr. Saeed while emphasizing the need to raise awareness about its rising incidence. He explained that the thyroid gland is a butterfly-shaped organ located at the front of the neck. Although small in size, it is a major gland in the endocrine system and affects nearly every organ in the body.
Dr. Saeed shared that there are two common thyroid conditions namely, hypothyroidism (under-active thyroid gland) and hyperthyroidism (overactive thyroid gland). Symptoms associated with these conditions can appear at different times in different people, and the safest bet is to consult an endocrinologist. Diagnosis is done through a simple blood test, which costs no more than Rs. 700, he said.
Dr. Ali Jamal from Shaheed Zulfiqar Ali Bhutto Medical University-PIMS, and also the vice

president of PES, informed that women constitute 9 out of 10 patients with thyroid-related conditions. He urged pregnant women in particular to have their diagnostic test done to prevent permanent damage to the child’s brain due to the mother suffering from hypothyroidism.
Dr. Abbas Raza from Shaukat Khanum Memorial Trust Hospital maintained that just as the thyroid gland itself works in the body in a silent fashion; its symptoms too are silent. “We all experience fatigue, body aches, lack of unnatural weight gain, and loss of sleep. As a result, when the condition starts, we tend to overlook the warning signs because unlike other diseases, it does not come with strong symptoms.
Dr. Najmul Islam from Aga Khan University Hospital informed that since the thyroid gland has a profound impact on metabolism, and affects every part of the body. He said that aside from hypothyroidism and hyperthyroidism, goitre and cancer of the thyroid are the other two ailments associated with this gland. He said timely diagnosis as lead to guaranteed treatment and cure. Luckily, the prognosis of thyroid cancer too is very good if treated in time. “Throughout the world, it is being diagnosed at stage 1 and is being completely cured,” he added.
Dr. Abdul Basit from Baqai University attributed the rising incidence of hypothyroidism to increasing life expectancy. On another note, he pointed out that “the concept of preventive medicine is totally non-existent in Pakistan. We have a sick care system, not a health care system,” he maintained, urging people to pay heed to preventive treatment.
Dr. Amin from Hayatabad Medical Complex emphasised that these conditions require lifelong treatment, which must be carried out under the supervision of an endocrinologist.
Dr. Zaman Sheikh from Sir Syed Medical College, Karachi, stated that children suffering from these conditions often suffer from depression, dullness, weakness of bones, and lack of interest in studies. He said, owing to its non-specific symptoms, a majority of the GPs themselves remain blinded to the possibility of an ailment being related to the working of the thyroid gland. “Always consult a senior doctor and get your diagnostic tests done from a reliable laboratory,” he advised.
Dr. Faisal Qureshi guided that thyroxin should be taken on an empty stomach and that patients should take Calcium and Vitamin D at night. He said, many patients think they will have to undergo surgery, which is recommended only in patients who experience difficulty in breathing and swallowing.
Short and crisp messages delivered by the endocrinologists added to the beauty of the seminar, which was followed by an interactive session with patients and the general public. Patient experiences revealed that doctors themselves are not trained to diagnose thyroid-related conditions; that there is an acute and perpetual shortage of thyroxin in the market; and that there are hardly any lady endocrinologists in Pakistan.
The endocrinologists called for a national study to ascertain the incidence of thyroid-related conditions. They stated that whenever a local study is conducted, 5 to 10 per cent of the population is found to be affected; yet such studies are hypothetical and cannot be generalised. “But for all we know, more than 400% of the patients may not have been diagnosed, which makes it essential to gather nationally representative data,” they maintained.
Patients were assured that a multinational company will soon start manufacturing thyroxin locally so problems related to persistent shortage of the life-saving drug will be overcome within the next two months. With reference to shortage of endocrinologists, they were informed that the College of Physicians and Surgeons of Pakistan, Karachi, has been persuaded to locally train FPCS doctors, which will lead to a gradual increase in expertise as well.
The role of the media in raising awareness about conditions related to the thyroid gland also came up. How much we know about these conditions became apparent when a colleague put the following question to this scribe before the start of the seminar: “What is thyroid. Is it something related to the thighs?” This tells us how important it is to build awareness about a disease domain so far marked by perpetual neglect.

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