Focus on hypothyroidism

Description

The thyroid gland is found in the front of the neck below the larynx (voice box) and has two lobes, one on each side of the windpipe. The thyroid is one of the endocrine glands, special groups of cells that make hormones. Hormones are chemical messengers that provide instruction to the organs and tissues of the body in order to control processes such as metabolism, growth and mood.

Hypothyroidism, also known as underactive thyroid, is a condition where the thyroid gland does not create enough of a thyroid hormone called thyroxine.

Hypothyroidism can occur due to the thyroid gland failing to work properly, or due to the thyroid gland not being stimulated properly by the hypothalamus or pituitary gland.

The signs and symptoms of hypothyroidism

Thyroid hormones affect numerous bodily systems, meaning that the symptoms of hypothyroidism are wide-ranging and diverse, affecting different people in different ways.

Symptoms of hypothyroidism include:

• Fatigue
• Weight gain
• Cold intolerance 
• Joint and muscle pain 
• Constipation 
• Dry skin 
• Thin, brittle hair or fingernails 
• Decreased sweating
• Heavy periods (menorrhagia) 
• Slowed heart rate 
• Weakness 
• High cholesterol 
• Puffy face, feet and hands

Possible causes of hypothyroidism

Hashimoto's disease

The most common cause of hypothyroidism is Hashimoto's disease, also known as chronic lymphocytic thyroiditis or autoimmune thyroiditis. It is an autoimmune disease - a disorder where the body's immune system attacks the body's own cells and organs. Hashimoto's disease causes the immune system to attack the thyroid gland, leading to inflammation and interference in its ability to produce thyroid hormones.

Thyroiditis

Thyroiditis is the inflammation of the thyroid gland. It causes thyroid hormone to leak into the blood, raising overall levels and leading to hyperthyroidism.

Congenital hypothyroidism

In cases of congenital hypothyroidism, babies are born with a thyroid gland that does not function properly. Congenital hypothyroidism can lead to problems with physical and mental growth problems, but early treatment can prevent these complications.  

How to register on the chronic programme

Once you have been diagnosed, please ask your doctor to contact our Chronic Medicine Department on 0860 11 78 59 to register you on the Chronic Medicine Management Programme.  

The chronic benefit consultant will liaise with your doctor regarding your treatment. Once the diagnostic criteria have been met and x-rays (if applicable) and relevant blood results have been submitted, the treatment will be approved. 

We will let you know whether the treatment falls within the Momentum Medical Scheme Reference Price. If the cost is greater than the Momentum Medical Scheme Reference Price, you will need to pay the difference. 

Once you receive authorisation, you can take your prescription to your designated service provider to get your medication, and the claim can be submitted. A designated service provider (DSP) is a healthcare provider (doctor, pharmacist, hospital, etc) that is a medical scheme’s first choice when its members require diagnosis, treatment or care for a Prescribed Minimum Benefit condition.

If you voluntarily choose not to use the DSP and choose to rather use a different hospital, doctor or pharmacy, a co-payment may apply.

The authorisation of your prescription is valid for 6 months. Your treating doctor will review your chronic condition 6-monthly and update your prescription when required. 

• If there are no changes to the medication and/or diagnosis, the prescription can be sent directly to your DSP pharmacy. 
• If there is a change to your medication prescription and/or diagnosis, then your doctor or pharmacist can contact us on 0860 11 78 59 to review the changes and renew the authorisation.

For more on your chronic benefits and where to obtain chronic medicine and treatment, click here.

Hospitalisation

If you need to be hospitalised for complications related to your illness, log in to the Momentum App, contact us via the web chat facility on momentummedicalscheme.co.za, email us at [email protected], send us a WhatsApp message or call us on 0860 11 78 59 to request pre-authorisation. We will allocate a case manager to follow up regarding your hospital stay.

Treatment plan 

Once you are registered on the programme, you will have access to a treatment plan, which may include cover for tests, doctors’ visits or other benefits considered medically necessary by your doctor, these will be reviewed by our clinical team to ensure appropriateness. 

Compliance 

You need to:

• obtain your chronic medication on a monthly basis, 
• make sure that you take your medication according to the dosage and quantity prescribed by your doctor, and 
• make sure that you do not miss a dose - this is not only important for compliance, but it can have serious implications for your health and wellbeing. 

Please make sure your claims have the appropriate ICD-10 code

It is important for all claims to include the appropriate ICD-10 codes (diagnostic codes), so we can identify the claim correctly and pay it from the Chronic Benefit. 

We may pay claims from your Day-to-day Benefit if:  

• The claims are submitted without the relevant ICD-10 codes. 
• You have exceeded the frequency limit on consultations or tests. 
• The treatment is not clinically appropriate. 

Contact us 

You can contact us via the web chat facility on momentummedicalscheme.co.za, email us at [email protected], send us a WhatsApp message or call us on 0860 11 78 59.

Glossary of terms

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