Archive for May 15th, 2009


Friday, May 15th, 2009

Unfortunately about 40 per cent of cases relapse when the drugs are stopped, and then operation is usually considered.

Operation with removal of most of the thyroid gland is used when medical treatment fails or where the gland is nodular or grossly enlarged.

In people over 40 radioactive iodine is the treatment chosen. Iodine is a major constituent of thyroxin and when the radioactive isotope is given it is taken up by the thyroid gland and the radiation destroys the over-active tissue.

The aim of operation is to remove about three-quarters of the gland and the remaining tissue is usually sufficient to maintain normality.

Occasionally, too much of the gland is removed or the other medical treatments destroy most of the gland and so the reverse condition of myxoedema may develop.

This is easily treated by giving patients thyroxin tablets which they have to take for the rest of their lives.

Occasionally the over-activity of the body and too rapid beating of the heart may lead to abnormalities of rhythm of the heart or even to heart failure.

The heart condition usually needs to be controlled before the thyroid gland can be adequately treated. In some people the onset of thyrotoxicosis seems to be precipitated by severe emotional shock.



Friday, May 15th, 2009

No one’s perfect, and that applies to doctors just as much as other people.

Doctors increasingly are under attack in Australia and elsewhere. We are accused of thinking more of our incomes and status than of our patients.

We are accused by the political parties, by the media, and by the public.

Some of these criticisms are justified. But most are not.

But I will admit that we do have one fault. And to me, this is the basis of all the mistrust and lack of understanding which occurs between us and those we serve — our patients.

We don’t know how to communicate.

Most doctors are hard-working, competent, and concerned about their patients’ welfare. But we can’t seem to establish rapport, or a two-way communication, with our patients.

A doctor needs to be a good diagnostician — that is, he needs to find out what is wrong with the patient. And he needs to be a good therapist — he needs to know how to treat the patient’s complaint.

But the best diagnostician and the best therapist still may not satisfy the patient if the doctor is not capable of two further things.