It is important to treat hypothyroidism because if it is untreated, many bodily functions can be "slowed down".

Some symptoms and physical signs associated with hypothyroidism include feeling constantly tired, dry skin, hair loss, constipation, leg cramps and weight gain. In women, menstrual periods may become heavier.

Your doctor is right that you can get a slow pulse and, in extreme situations of low thyroid hormone, the patient's metabolic rate can even fall to a critical level and he may develop a potentially fatal state known as myxedema coma.

Thyroxine is the key medication used to treat hypothyroidism and it is very safe to use.

It may not be the cause of your hunger, so you may need to explore this issue with the gastroenterolo- gist who performed your scope.

Some possible ways of consuming the medication, which may be useful to you, include starting with a small dose and gradually working your way up to the dose required, with the help of your doctor.

I have patients who have chosen to take their thyroxine before bedtime instead of in the morning. Studies have shown that this can be as effective as taking the medication in the morning.

It is very important to remember that thyroxine should always be taken on an empty stomach and never at the same time as other medications. It is best absorbed when taken on an empty stomach with just a glass of water.

Mixing it with other medications, in particular, calcium and iron-containing medications, will result in poor absorption of the thyroxine.

In addition, thyroxine requires stomach acid for good absorption. If you are taking medications that affect your stomach acidity, your doctor needs to know and your dose of thyroxine may need to be adjusted.

Do work closely with your doctor on these issues.

Dr Adoree Lim

Consultant at the department of endocrinology at Singapore General Hospital