Knowledge, Awareness and Practice of Patient with Primary Hypothyroidism Among the Patient Attending at Endocrinology Care Center: A Pharmacist Intervention

Hypothyroidism is a common endocrine disorder with a prevalence of 1-2% in the world. The symptoms of hypothyroidism includes, cardiac dysfunction, dyspnea and reduced exercise tolerance, overt cardiovascular diseases, and diabetes mellitus. The aim of the study was to access Knowledge, awareness and, the practice of patient with primary hypothyroidism among the patient attending at endocrinology care center. In this study, most of the female patients were seen hypothyroid than males. Out of a total of 164 respondents, 5.5% were age group of 15-24, 52.4% were age group 25-44, 39% were from the age group 45-64 and 3% were above 65. Among the studied population, 93.9% were male and e other ware female. The majority of the respondent was in the age group of 25-44 years (52.4%). Major differences were seen after the intervention regarding the Knowledge about thyroid and hypothyroidism. Before intervention respondent was more unknown towards the test required for treatment and similarly after the intervention improved the understanding level of patients towards hypothyroidism. Hence this study suggested advantages of intervention by pharmacist in improving knowledge, attitude and practice of patients towards management of disease.


Introduction
The thyroid gland is butterfly-shaped and sits on the trachea, in the anterior neck which is the largest endocrine gland in the body.
Thyroid hormones (THs) produced by the thyroid gland are involved in metabolic hemostasis in the body. Thyroxine (T4) and triiodothyronine (T3) are the two major types of TH present in the body which involves in regulating metabolic functions 1,2 .
Hypothyroidism indicates inadequate production of thyroid hormone by the thyroid gland which can be primary (abnormality in the thyroid gland itself) or secondary/central (as a result of hypothalamic or pituitary disease). Approximately 99% of cases of hypothyroidism is the etiology cases of primary hypothyroidism 3 .The worldwide prevalence of spontaneous overt hypothyroidism is between 1% and 2% and ten times more common in women than in men while approximately 8% of women and 3% of men have subclinical hypothyroidism 4 .
Patient's knowledge and awareness about diseases and its treatment is very important for good long term outcomes and compliance in any chronic diseases 5 . It has also been observed that faulty practices prevail among these patients. There is an inadequate of data regarding knowledge and practices among treated hypothyroid patients. It has been recognized that general awareness about hypothyroidism is poor and is associated with inadequate knowledge, wrong beliefs, and practices in a  Consent was taken to use the questionnaire.

Inclusion and Exclusion criteria
Hypothyroid patients of age range 18-75 years visiting the endocrine department as OPD patients were included in the study. Similarly, Psychiatric patients and Hospitalized patients with thyroid dysfunction were excluded from this study.

Ethical approval
The study was approved by Institutional Review Committee (IRC), Pokhara University Research Centre Kaski, Nepal and data collection approval were obtained from endocrinology care center, Pokhara, Nepal. The data were collected in a structured pro forma, which include the validated KAP questionnaires and follow up was carried after one month.

Statistical Analysis
After collection of the data, data was entered and analyzed in

Socio-demographic characteristics of the study population
The detail of socio-demographic characteristics is given in Table   1. Out of a total of 164 respondents, 5.5% were age group of 15-24, 52.4% were age group 25-44, 39% were from the age group45-64 and 3% were above 65.Among the studied population, 93.9% were male and the rest other was female. The majority of the respondent was in the age range of 25-44 years (52.4%).
Among the respondent, based on caste, 47% were of upper caste group followed by relatively advantage Janajati 18.3%. It was found that 7.9% of respondents were illiterate and only 11% of respondents had studied bachelor degrees or above. Similarly, 70.1% were unemployed and the rest of others were employed .Overviewing the residence (85.4%) were of town residence, (16.6%) were village residential people.

Respondent on medication
Among the respondent, 163 were on medication and rest was not on medication. Similarly, the respondent who uses alternative medicine was less than those who don't use it. Certain modifications were made in respondent life for a healthy life which is given in Table 2. Table 3 represents the knowledge about thyroids and hypothyroidism before and after the knowledge was given. It was observed that before the intervention thyroid definition was a disease (54.9%), swelling on neck (26.2%) and a normal gland in the body (18.9%).  Similarly, after intervention, the respondent answer the definition as a disease (0.6%) and a normal gland in the body (99.4%).

Knowledge about thyroid and hypothyroidism
Major differences were seen before and after the intervention.   Table 4 represents the concept of the respondent regarding symptoms of thyroidism and major differences were seen before and after the intervention.

Common Misconception regarding hypothyroidism
The common misconception regarding hypothyroidism improved after the intervention as shown in table 5. The medication practice and belief regarding the interval between thyroid medicine and food, the correct response was seen in 87.8% incorrect response in 7.3% and 4.9% were unknown.

Knowledge of basis of treating hypothyroidism
The reason for treatment was seen to stimulate the thyroid gland to work(82.3%) for intervention while after intervention all the respondents respond to stimulate the thyroid gland to work as shown in Table 7.

Test required for treatment
Before the intervention respondent was more unknown towards the test required for treatment and similarly after the intervention the respondent has responded to the correct answer which can be clearly seen in table 8.

Time to have medicine
It was seen that before intervention the time to have the medicine was at empty stomach (93.9%), empty stomach and an interval of at least 30 min before taking coffee or tea in the morning (0.6%), with food, milk or juice (5.5%) while after intervention time was empty stomach (98.8%) and the rest were empty stomach and an interval of at least 30 min before taking coffee or tea in the morning as shown in table 9.

Percentage of levothyroxine prescribed
Different dose of levothyroxine has been prescribed for treating different conditions. Levothyroxine 25mcg with 37.20% has been prescribed more among the respondent while the least prescribed was levothyroxine 125mcg with 1.2% as given in figure 1.

Biochemical Test value
The Biochemical Test values are given in   With food, milk or juice 9(5.5) 0 After food 0 0

Conflict of interest
The authors have no current conflict of interest.

Author's contributions
GMK supervised, and draft the manuscript. SP participated in the collection of data, arranged in tabular form, and carried out the literature review. All authors read and approved the final manuscript.