FROM THE HISTORY1
Goiter was first described in China in 2700 BC. Da Vinci described thyroid as a thing that is designed to fill empty spaces in the neck. According to Parry – thyroid works as a buffer to protect the brain from surges in blood flow. Roman physicians have reported thyroid enlargement as a sign of puberty. In 500 AD Abdul Kasan Kelebis Abis performed the first goiter excision in Baghdad, the procedure remained unknown. In 1200s AD advancements in goiter procedures included applying hot irons through the skin and slowly withdrawing them at right angles. The remaining mass or pedicled tissue was excised. Patients were tied to the table and held down to prevent unwanted movement, but most died from haemorrhage or sepsis. In 1646 AD Wilhelm Fabricus performed a thyroidectomy with standard surgical scalpels, for which he was imprisoned. In 1656 thyroid was first identified by the anatomist Thomas Wharton. In 1808 AD Guillaume Dupuytren performed a total thyroidectomy, but the patient died postoperatively of “shock”. In 1820 AD Johann Straub and Francois Coindet found that use of seaweed (iodine) reduced goiter size and vascularity. In 1830 AD Graves and von Basedow describe a toxic goiter condition they referred to as “Merseburg Triad” – goiter, exopthalmos, and palpitations. In 1866, Samuel David Gross said, “If a surgeon should be so foolhardy as to undertake it [thyroidectomy] … every step of the way will be environed with difficulty, every stroke of his knife will be followed by a torrent of blood, and lucky will it be for him if his victim lives long enough to enable him to finish his horrid butchery.” In 1883, Theodor Kocher while addressing the German Medical Congress stated, “The thyroid gland in fact had a function”. In the same year Kocher’s performed a retrospective review on 5000 career thyroidectomies. The thyroxine was discovered somewhere in 19th century and a remarkable turning point started with this in management of thyroid disorders by allopathic counterparts.
REFERENCES FROM THE LITERATURE2
The homoeopathic literature is loaded with vast examples of thyroid diseases and their cure with homoeopathy. It was the insight of our great masters that they have so beautifully described thyroid related disorders and their management in Homoeopathy. In his great work, Master Samuel Hahnemann has quoted, “What action is exerted on the skin by certain diseases of the glands with an internal secretion (thyroid gland, ovaries, testicles, supra-renal capsules, pituitary gland, etc.) must remain reserved for future research. So much, however, is established to-day to prove that some of these disturbances (Addison’s disease) cause considerable alterations of the skin.” Below are some of the references from the history regarding thyroid disorders and their Homoeopathic cure.
CASE STUDIES PRESENTED SO FAR2
- Journal of Homoeopathic Clinics, Vol 3, Sep N’1, Case 458, 1869-1870: A 19 years old female with large swelling of the thyroid gland was treated with Bromine 3, several times a day following by Calc Carb 3 and was relieved in three weeks of time.
- International Hanhnemannian Association 1902: A case of thyrotoxicosis was treated by Homoeopathically chosen remedies: China, Lachesis, Sul.
- Clinical Illustrations Homoeopathician (A Journal Of Pure Homoeopathy) 1914: presented 3 cases of thyroid enlargement with thyroid dysfunction and were reported cured by Iodum and Baryta carb.
- International Hahnemannian Association 1919: “Our knowledge of the endocrine remedies is as yet in a formative stage, but the therapeutic use of the ductless glands is steadily growing. We know more of the thyroid gland and of its therapeutic applications, than of any of the other ductless glands.” There is also a case presented which was treated using 2x and 3x trituration of thyroidinum.
- International Foundation for Homoeopathy: Case Conference Proceedings 1995: A case of primary hypothyroidism aged 30 female was presented by Dr. George Guess.
- Master F. J. , 1995: A case of a lady aged 51 years with migraine of 15 years standing, hypothyroidism since 10 years and leucoderma since 5 years and a diagnosed as a case of Hypothyroidism was given Staphisgaria.
REFERENECES FROM MATERIA MEDICA2
- Blackwood A. L. Manual of materia medica therapeutics: “A normal thyroid has much to do with the function of the ovaries; with a hypothyroid condition, although the ovaries and uterus are normal, menstruation may not appear and the patient becomes obese, the skin dry; should the pituitary show disturbance, the skin will be moist and soft”.
- American Homoeopath described the concept of Hypothyroidism, cancer and clinical depression.
- Boericke W. Pocket manual of homoeopathic materia medica: Kali Carb: “Pain in small spot on left side Hypothyroidism”. Thryroidinum: “Marked sensitiveness to cold, Hypothyroidism after acute diseases, i.e. weakness.
- Grand George D. The spirit of homoeopathic medicines: “At times the remedy is suggested by hypertrophied glands or the beginning of goiter. Homeopathic treatment will remedy a slight disorder in the glandular system, but when the disorder is too great, hormonal treatment will be necessary.
- Lesser O. Textbook of Homoeopathic Materia Medica: “If the alkali and earthy alkali metals, Na, K, Mg, Ca, as cations determine the drug picture, then they shape it as hydrogenoid, cold, sensitive to cold, relaxed torpid lymphatic constitutional types stigmatized along the side of the parasympathetic system. Seen from an endocrine side, they tend toward the hypothyroid side, the function of the lymphocytic apparatus (thymus) is increased.”
- Master F. J. The bed side Organon of Medicine: “Never give thyroidinum as a routine or specific for all patients who come with thyroid problem.”
REFERENCES FROM REPERTORY3
There are 32 references in the forms of rubrics and subrubrics given in Synthesis treaure edition. Whereas Kent’s repertory, Murphy repertory and Complete repertory consists of 9, 13 and 37 rubrics in relation to thyroid and other rubrics and vice versa respectively.
The thyroid gland starts developing by 3-4 weeks of gestation, appearing as an epithelial proliferation in the floor of the pharynx. Follicles of the thyroid begin to make colloid in the by 12th week of gestation and thus contribute in development of physical and neurological features. Failure of synthesis of hormones and TSH by thyroid gland may result in arrested or abnormal growth of the fetus. At birth, a cold-stimulated short-lived TSH surge is observed, followed by a TSH decrease until day 3 or 4 of life by T4 feedback inhibition.
ANATOMY OF THYROID GLAND5
FUNCTIONS OF THYROID GLAND6
The thyroid gland is one of the most important endocrine gland which secrets two major hormones, thyroxine and triiodothyronine. It is situated in the anterior part of the neck just above the lower part of the trachea, situated in between the cricoid cartilage and suprasternal notch. Normally it is not palpable but may be palpated in conditions in which it is enlarged. Enlargement of the gland may not be a sign of its under or over functioning, but association of goiter with thyroid function status and other investigative modalities helps us to understand disease in a better term. Goiter is assessed by palpation by fingers of both hands for size, consistency and presence of nodules if any.
Thyroid palpation method
Thyroxine (T4) and tri-iodothyronine (T3) are two major hormones that are secreted in pulsatile manner under feedback mechanism controlled by hypothalamic-pituitary-thyroid-pituitary axis.
DIAGNOSING VARIOUS THYROID DISORDERS
The diagnosis of thyroid disorder is primarily done on following points:
- Complete homoeopathic case taking.
- Family history of systemic disorders particularly thyroid and autoimmune disorders. It is seen that the individuals who have family history positive of thyroid dysfunction are at greater risk of developing thyroid disorders.
- Consistancy and size of thyroid gland, as it may give us some hint about the underlying pathology, e.g. firm gland are suggestive of Hashimoto’s thyroiditis, goiter in high grades can induce pressure symptoms on trachea and other adjacent tissues, painful gland suggests acute or subacute inflammatory condition.
- Presence of anti thyroid antibodies, may suggest some of the thyroid dysfunction.
- Other investigations also help in arriving at diagnosis of thyroid disorders. Some of the investigations are: Radioactive iodine uptake (RAIU), Technetium scan (Tc Scan), Fine needle biopsy (FNB). These investigations are condition specific and are to be advised as per requirement of the case. The detailed description of these investigative modalities is described later in the following text.
The ultimate and ground level workers in thyroid-body axis are the two hormones secreted by thyroid gland. These hormones are responsible for various activities in almost the entire body. Every organ and tissue thus needs these hormones (particulary T3) for proper functioning. Thyroid hormones acts by crossing the cell membrane and binding to intracellular receptors (?1, ?2, ?1 and ?2), which act alone, in pairs or together with the retinoid X-receptor as transcription factors to modulate DNA transcription and thus various metabolic and other functions are performed. There are two variants of thyroid hormones circulating in body; free and bounded hormones, as hormones are circulated along the body in protein-bound form. These proteins are majorly thyroid binding globulins (TBG) and less commonly albumin. According to extensive research studies done on this reveals that free hormone assay is more reliable as bound hormones level may vary in conditions in which there is pooling of TBG in body eg.,
- Estrogen therapy
- Oral contraceptive pills
- Acute viral hepatitis
- Primary biliary cirrhosis
- Hepatocellular cancer
- Collagen vascular disease
On the other hand TBG in decreased in
- Nephrotic syndrome
- Protein-losing enteropathy
- Critical illness/starvation
T4 (thyroxine) is the major circulating hormone whereas T3 is more biologically active. Both T3 and T4 give a feedback to pituitary to release or suppress secretion of TSH. TSH is ultrasensitive to even smaller amouts of circulating T3 and T4 levels, this phenomenon is to be understood at the ground level to understand the diagnosing and follow up cases of thyroid disorders. This can be understood by the following simple yet informative flow chart: