Thoth covers all forms of learning from simple skills to advance education. He was also the lord of time, so all aspects of karma are covered by this card including Good Fortune if upright or bad luck if reversed.
Thoth was also the keeper of the akashic records, the scribe to the gods and the patron of healers. His appearance in this initial position of the reading would indicate that your question deals with one of the following matters – akashic healing, karma, healing or health, the law, for education in all of its forms.
Thoth is the card that implies that the issue in question very firmly forms part of your life lessons this time around. It’s a fundamental part of what you’ve come to Earth to learn during this lifetime.