An excerpt from Yankee Doctor in the Bible Belt: A Memoir.

Doctoring in the mountains of Eastern Kentucky, I met Mrs. Snoop, a new patient at the clinic. She is 38 years old. Her chief complaint, according to her husband, is “not wanting to have sex.” He speaks on her behalf, sitting in the corner in grease-spattered overalls and heavy work boots.

On examination, Mrs. Snoop appears markedly older than 38. Her skin is puffy and coarse, she is overweight, and her speech is slow. Upon further questioning, it emerges that she used to be on Synthroid, a detail offered by her husband. The patient herself is a woman of few words.

She took Synthroid last year after being diagnosed with low thyroid hormone. Her husband tells me, “She felt better after six months on the medicine, so she quit using it.”

I ask more questions related to signs and symptoms of hypothyroidism. She has gained a lot of weight in the interim, her periods have disappeared, and she is tired all the time. None of these complaints seemed to bother the husband. The only one that really got to him was her lack of interest in sex.

The patient shows all the signs of dangerously low levels of thyroid hormone. I tell them that she needs to go back on the medicine and stay on it for the rest of her life.

The husband isn’t sure she needs it. I patiently explain, “She won’t want to have sex unless she stays on Synthroid!”

This got his interest. She restarted Synthroid.

I see her on a follow-up visit four weeks later. She is a new woman—bright, talkative, and slender. She looks ten years younger, and the husband is happy.

What this taught me:

Know your audience. The intricacies of hypothyroidism and the fact that it can kill you if untreated did not grab the husband’s interest. The lack of sex did. You have to go with whatever hook you have.

Janet Tamaren is a family physician and author of Yankee Doctor in the Bible Belt: A Memoir.