A FAILURE OF HEALTHCARE DELIVERY SYSTEM: LESSONS TO BE LEARNT FROM CLINICAL PRACTICE

Hypothyroidism is a known complication in patients who receive neck irradiation, and thyroid function should be monitored in the follow-up (2). Hyperurecaemia is associated with hypothyroidism, therefore serum uric acid levels should be checked in those found to be hypothyroid (3). Macrocytosis is associated with hypothyroidism and therefore red cell indices should be checked (4). Hypothyroidism is known to be associated with a consistent elevation in serum creatinine levels, which is corrected once the euthyroid status is restored (5). Cholesterol levels are reported to be raised in hypothyroidism and should be monitored (1).

CASE REPORT
A 52 year-old businessman who had laryngectomy, followed by radiation therapy in the middle of 2001, was on regular follow-up of an Oto-rhino-laryngologists. He was seen in Family Medicine Clinic after almost two years, for the evaluation of un-explained weakness. His past medical history and family history were unremarkable. He continued to chew tobacco. On examination he appeared pale, had a pulse of 60/minute, regular and his thyroid gland was not found enlarged.

Investigations showed a Haemoglobin of 12.3gram/dl, Mean corpuscular volume of 102.9 Fl, with macrocytosis on peripheral film. His Thyroid Stimulating Hormone was >75 uIU/ml, with reduced Serum free T4 and Serum T3. His Serum Cholesterol was 209 mg/dl while Serum Creatinine was 2.0 mg/dl. Both Serum B12 and Serum folate levels were normal. He was started on thyroxine replacement and tobacco use cessation program.

CONCLUSION
Follow-up of cancer patients is shown to be not in line with the standard recommendations (6). The role of Primary Care Physician is mandatory in the follow up of such cases. It is recommended and we strongly support follow-up of cancer patients jointly by the Primary Care Physician and the Sub-Specialist.