Focus on hypothyroidism

What is hypothyroidism? The thyroid gland is a butterfly-shaped organ located in the front of the neck, just beneath the larynx, or voice box. It consists of two lobes, one situated on each side of the windpipe. As part of the endocrine system, the thyroid gland plays a crucial role in the body's hormonal balance. It produces hormones that act as chemical messengers, conveying essential instructions to various organs and tissues. These hormones are vital for regulating numerous bodily functions, including metabolism, growth, and emotional wellbeing.

Hypothyroidism, commonly referred to as an underactive thyroid, is a medical condition in which the thyroid gland fails to produce sufficient amounts of a specific hormone known as thyroxine. This hormone is critical for maintaining the body's metabolic processes and overall health.

Hypothyroidism can arise from various factors. It may occur when the thyroid gland itself is not functioning properly, which could be due to damage or disease. Alternatively, it can result from inadequate stimulation of the thyroid gland by the hypothalamus or pituitary gland, which are parts of the brain responsible for regulating hormone production.

The signs and symptoms of hypothyroidism are diverse and can affect many different systems within the body. Since thyroid hormones influence a wide range of bodily functions, individuals with hypothyroidism may experience a variety of symptoms, which can manifest differently from one person to another.

Common symptoms of hypothyroidism include:

• Fatigue: Many individuals report a persistent sense of tiredness that does not improve with rest.
• Weight gain: Unexplained weight gain can occur, often despite a stable diet and exercise routine.
• Cold intolerance: People with hypothyroidism may feel unusually cold, even in warm environments.
• Joint and muscle pain: This condition can lead to discomfort and stiffness in the joints and muscles.
• Constipation: Slowed metabolism can result in digestive issues, including constipation.
• Dry skin: Skin may become rough and dry due to reduced moisture retention.
• Thin, brittle hair or fingernails: Hair and nails may become weak and break easily.
• Decreased sweating: Individuals may notice a reduction in their ability to sweat.
• Heavy periods (menorrhagia): Women may experience heavier menstrual bleeding than usual.
• Slowed heart rate: The heart rate may become slower than normal, which can lead to other health issues.
• Weakness: Generalized weakness can affect daily activities and overall quality of life.
• High cholesterol: Hypothyroidism can contribute to elevated cholesterol levels in the blood.
• Puffy face, feet, and hands: Swelling in these areas can occur due to fluid retention.

Possible causes of hypothyroidism vary, with several underlying conditions contributing to the development of this disorder. One of the most prevalent causes is Hashimoto's disease. This autoimmune disorder, also referred to as chronic lymphocytic thyroiditis or autoimmune thyroiditis, occurs when the body's immune system mistakenly attacks its own thyroid gland. This attack leads to inflammation and disrupts the gland's ability to produce necessary thyroid hormones.

Thyroiditis is another potential cause, which involves inflammation of the thyroid gland. This condition can result in the release of excess thyroid hormone into the bloodstream, initially causing symptoms of hyperthyroidism before leading to hypothyroidism as hormone levels eventually drop.

Congenital hypothyroidism is a condition that affects newborns, where the thyroid gland is either absent or not functioning correctly from birth. This disorder can lead to significant developmental issues, both physically and mentally. However, with early detection and treatment, many of these complications can be effectively prevented.

How to register on the chronic program If you have received a diagnosis of Addison’s disease, it is essential to have your doctor contact our Chronic Medicine Department at 0860 11 78 59 to initiate your registration on the Chronic Medicine Management Programme. A chronic medicine consultant will work closely with your healthcare provider to coordinate your treatment plan. Once the necessary diagnostic criteria are satisfied and relevant blood test results are submitted, your treatment will be approved. We will inform you whether your prescribed treatment is covered under the Momentum Medical Scheme formulary or if you will be required to make a co-payment. After receiving authorization, you can present your prescription to your designated service provider to obtain your medication, and the claim will be processed accordingly. A designated service provider (DSP) refers to a healthcare professional—such as a doctor, pharmacist, or hospital—considered the preferred choice by the medical scheme for diagnosing, treating, or caring for a Prescribed Minimum Benefit condition. If you opt not to use the DSP and choose an alternative healthcare provider, a co-payment may apply. Typically, the authorization remains valid for 12 months. If there are no changes to your required medication, your doctor or pharmacist can reach out to us at 0860 11 78 59 to renew the authorization. The same process will be followed for any modifications or additions to your treatment plan.

For additional details regarding your chronic benefits and where to access chronic medications and treatments, click here.

Hospitalization If hospitalization is necessary due to complications from cardiac failure, you should log in to the Momentum App or reach out to us through our web chat feature available at momentummedicalscheme.co.za. You can also email us at [e-mail], send a WhatsApp message, or call us at 0860 11 78 59 to request pre-authorization for your hospital stay. A case manager will be assigned to follow up on your hospitalization process.

Treatment plan Once you are registered in the program, you will receive access to a tailored treatment plan. This plan may encompass coverage for various tests, consultations with doctors, and other medically necessary benefits as determined by your healthcare provider. All elements of this plan will be subject to review by our clinical team to ensure their appropriateness and necessity.

Compliance It is crucial for your health and treatment success that you adhere to the following guidelines: you must obtain your chronic medications on a monthly basis, ensure that you take your medications as prescribed in terms of dosage and quantity, and avoid missing any doses. Compliance is not only vital for the effectiveness of your treatment but also essential for your overall wellbeing.

Please ensure your claims include the appropriate ICD-10 code It is imperative that all claims submitted include the correct ICD-10 codes, which are diagnostic codes that help us accurately identify and process your claim through the Chronic Benefit. In cases where claims are submitted without the relevant ICD-10 codes, or if you exceed the frequency limits for consultations or tests, the claims may be paid from your Day-to-Day Benefits instead. Additionally, if the treatment is deemed not clinically appropriate, similar adjustments may be made.

Contact us For any inquiries or assistance, you can reach us via our web chat feature at momentummedicalscheme.co.za, email us at [e-mail], send a WhatsApp message, or call us at 0860 11 78 59.

Glossary of terms Designated service providers refer to the network of healthcare providers, including associated general practitioners and specialists, as well as state facilities, that Momentum Medical Scheme utilizes to diagnose and treat members for Prescribed Minimum Benefits.

A formulary is a comprehensive list of medications that are covered under your specific plan, from which healthcare providers can prescribe suitable medications for chronic conditions.

ICD-10 refers to the International Classification of Diseases, 10th Revision, which is the diagnosis coding system used to classify diseases and health conditions.

Prescribed Minimum Benefits encompass a set of healthcare benefits that all medical schemes in South Africa are mandated to cover, as stipulated by the Medical Schemes Act 131 of 1998 and its accompanying regulations. To access these benefits, your medical condition must meet specific criteria and be included in the defined list of Prescribed Minimum Benefit conditions. Additionally, the treatment required must align with the treatments outlined in the defined benefits, and you must utilize the Scheme’s Designated Service Providers. For more information on Designated Service Providers, please refer to the definition provided on page 2.

If you decide to use non-designated service providers voluntarily, the Scheme will reimburse benefits up to the Momentum Medical Scheme Rate, and relevant co-payments will apply. However, if you utilize non-designated service providers in emergency medical situations, it is considered involuntary, and co-payments will be waived.