Clinical Cases

Hypothyroidism in a Woman of 29

Dr. Reetesh Ratnakar Shet shares a case of hypothyroidism in a woman of 29. Timidity, fear of dark, profuse menses and desires sweets were among the remedies leading to the simillimum.

PRELIMINARY DATA

  • Date of visit: 1/12/18
  • PATIENTS NAME: Mrs. D.D
  • AGE: 29 Years /Female
  • STATUS: Married
  • RELIGION: Hindu
  • OCCUPATION: House wife
  • ADDRESS: Lotoulim, Goa

PRESENTING COMPLAINTS

  • ℅ weight gain during pregnancy
  • ℅ Easy breaking of nails since 1.5 months after delivery
  • ℅ Pain in Right knee since 1.5 yrs
  • ℅ Pain in lower back since last 10 yrs

DETAILS OF PRESENTING COMPLAINTS

℅ weight gain during pregnancy ( from 59kg to 73kg at time of delivery) Was put on Tab. Thyroxine 75mg , 1/OD

℅ Easy breaking of fingernails and toenails as she has stopped T.thyroxine 1.5 months after delivery.

℅ Pain in Right knee since delivery
Pain < while standing from sitting position
Stiffness of joints present when she sits for long to wash clothes
Range of B/L knee joint is normal, no swelling, No warmth.

Pain in lower back since last 10 yrs
Sensation: As if weight present
Pain < bending, cannot rise from bending (it’s difficult)
Lumbago < during menses – during flow pain is more
< 1 to 2 days prior.
O/E (Local): tenderness present over L4 –L5 vertebrae.

PAST HISTORY – Nothing significant

PHYSICAL CHARACTERISTICS

Build- obese

Hair- Hair Fall +, No dandruff, No greying

Nails- No pallor, No Paronychia, brittle nails

Face – Symmetrical and expressive

Appetite- good

Diet- Mixed

Craving – Sweets +3

Aversion- NS

Thirst- 4 lit/day, warm water, Drinks as habit.

Stool 2 time /day semisolid satisfactory Non offensive
Perspiration Localised on scalp +3 Odour + Non Staining
Urine 5-6 times/day Pale yellow Can control No dysuria

MENSTRUAL FUNCTION

Menarche-10 yrs
LMP- 21.10.18
Menses:

Duration- 3 days , colour: dark maroon

Cycle-regular

Flow- heavy

Clots – present, small

Odour- No peculiar odour

Concomitant: Before- Pain in back  1- 2days prior

During: Pain increases on 1st day

After-pain present in hypogastrium

Leucorrhoea : present 4-5 days after menses

PREGNANCY, LABOUR, PUERPERIUM

G1 P1 L1 A0
Male 1.5 yrs

LIFE SPACE

Patient stays in a nuclear family. Husband, son and herself.

Fear of dark.

Gets angry easily but does not do anything during anger and remains silent.

She studied till graduation, wanted to do work but couldn’t, do due to her child.

THERMAL STATE- Hot patient 

COVERING Summer- No covering winter-thin Rainy- thin
BATH Summer- Cold Winter- Warm Rainy- Warm
FAN summer-Fast winter-fast Rainy- medium

GENERAL EXAMINATION

Eyes- No pallor, No ictrus

Tongue- Clean

Nails- No pallor, no deformities

Neck: No restricted movements in cervical spine .

Oedema- No periorbital swelling, No pedal oedema.

VITALS : T: 98 F  Pulse- 82b/m    RR- 17 resp/m   BP- 130/80 mmHg

SYSTEMIC EXAMINATION

RS – No Rales, No Ronchi.
CVS- S1, S2 rhythmically heard, No murmurs
GIT- No tenderness, No organomegaly.
GUT- No tenderness, Kidneys not palpable.
CNS- Well oriented in time and space

INVESTIGATION : 24.3.2018

24.3.2018

TSH 6.69 uIU/ml (0.3– 5.5 uIU/ml)

DIAGNOSIS

Hypothyroidism

  • TOTALITY OF SYMPTOMS
  • Remains quiet when angry
  • Fear of dark
  • Craving- sweets +3
  • Perspiration- scalp +3
  • Menses heavy
  • Hot patient
  • Pain in Right knee < Rising from sitting
  • Lumbago < rising from sitting
  • Lumbago < menses during

REPORTORIAL RESULT

REMEDY/PRESCRIPTION  (date: 1/12/18)

  1. Pulsatilla 200 3 pills / TDS x 3 days
  2. Rubrum 3—3—-3 x 15 days

 FIRST FOLLOW UP: 28.12.2018

     SYMPTOMS INTERPRETATION PRESCRIPTION
     ℅   weight gain, today’s weight: 68kg SQ 1. Pulsatilla 200

3 pills/TDS x 3

days

 

2. Rubrum 3—3–3 x 15 days

     ℅ Easy breaking of fingernails and toenails SQ
     ℅ Pain in Right knee x delivery

Pain < while standing from sitting position

Stiffness of joints present when she sits for long

 

>50%

     ℅   Pain in lower back

Sensation: As if weight present

Pain < bending, cannot rise from bending (it’s difficult)

>30%
C/o Nasal blockade, right sided, constant x 15 days

Discharges thin.

Itching of throat- present

     App – Good

Perspiration- scalp +, offensive

Thirst- 2 litre/day          Urine, Stools – No complaints

O/E: Nose: Right turbinate enlarged

Throat: No tonsillitis, No congestion

Vitals:

P: 79b/m , BP: 110/70mmHg , RR: 16 resp/Min

SECOND FOLLOW UP: 12.01.2019

     SYMPTOMS INTERPRETATION PRESCRIPTION
     ℅   weight gain , today’s weight: 68kg SQ 1. Pulsatilla 200

3 pills / TDS x 3 days

 

2. Rubrum 3—3—3

x 1 month

     ℅ Easy breaking of fingernails and toenails >>
     ℅ Pain in Right knee x delivery

Pain < while standing from sitting position

Stiffness of joints present when she sits for long

 

>50%

     ℅   Pain in lower back

Sensation: As if weight present

Pain < bending, cannot rise from bending (it’s difficult)

>60%
C/o Nasal blockade, right sided, constant x 15 days

Discharges thin.

Itching of throat- present

>20%

THIRD FOLLOW UP: 12.05.2019

      SYMPTOMS INTERPRETATION PRESCRIPTION
     ℅   weight gain SQ 1. Calc Sulph 200

3 pills / TDS x 3 days

 

2. Rubrum 3—3—-3

x 1 month

     ℅ Easy breaking of fingernails and toenails >>>
     ℅ Pain in Right knee

Pain < while standing from sitting position

Stiffness of joints present when she sits for long

 

>60%

     ℅   Pain in lower back

Sensation: As if weight present

Pain < bending, cannot rise from bending (it’s difficult)

SQ
C/o Nasal blockade, right sided,< Night, sneezing < Night

Discharges thin.

>50%
C/o itching in ears; has to put in ear bud to scratch

Itching < night, early morning

No otorrhoea

     App – Good

Thirst- 2-3 litre/day          Urine, Stools – No complaints

Weight: 67kg

FOURTH FOLLOW UP: 13.7.2019

     SYMPTOMS INTERPRETATION PRESCRIPTION
     ℅   weight gain, reduced by 1 kg >> 1. Calc Sulph 200

3 pills / TDS

x 3 days

 

2. Rubrum

3—3—3

x 1 month

     ℅ Pain in Right knee

Pain < while standing from sitting position

Stiffness of joints present when she sits for long

 

>60%

     ℅   Pain in lower back

Sensation: As if weight present

Pain < bending, cannot rise from bending (it’s difficult)

>
C/o Nasal blockade, right sided,< Night, sneezing < Night

Discharges thin.

>70%
C/o itching in ears , has to put ear bud to scratch

Itching < night, early morning

>50%
     App – Good

Thirst- 2-3 litre/day          Urine, Stools – No complaints

Weight: 67kg

FIFTH FOLLOW UP: 18.8.2019

      SYMPTOMS INTERPRETATION PRESCRIPTION
     ℅   weight gain , reduced by 1 kg >> 1. Calc Sulph 1M

3 pills / TDS

x 1 days

 

2. Rubrum

3—3—-3

x 1 month

     ℅ Pain in Right knee

Pain < while standing from sitting position

Stiffness of joints present when she sits for long

 

>70%

     ℅   Pain in Hypogastrium < during menses, 1st day

Cramping pain , pain last for 2-3 hrs

Nausea with pain

Sensation of passing stools during menses

C/o itching in ears >90%
     App – Good

Thirst- 2-3 litre/day          Urine, Stools – No complaints

Weight: 67kg

SIXTH FOLLOW UP: 3.11.2019

      SYMPTOMS INTERPRETATION PRESCRIPTION
     ℅   weight reduced >> 1. Calc Sulph 1M

3 pills / TDS

x  1 days

 

2. Rubrum

3—3—-3

x 1 month

     ℅ Pain in Right knee

Pain < while standing from sitting position

Stiffness of joints present when she sits for long

 

>90%

     ℅   Dysmenorrhoea

LMP- 19.10.2019, pain was mild

No sensation of passing stools during menses

>>
C/o itching in ears >, Now occasional
     App – Good

Thirst- 2-3 litre/day          Urine, Stools – No complaints

Weight: 67kg

THYROID REPORT: NORMAL: DONE ON : 3.10.2019 

Case by Dr. Reetesh Ratnakar Shet, under the guidance of  Prof.(Dr). Jyothi Vijaykumar, MD(Hom.)

HOD, Dept of Practice of Medicine, A.M Shaikh Homoeopathic Medical College PG Research Centre and Hospital, Belagavi

REFRENCES

1. Munjal YP, API Textbook of Medicine; 9th edition; Jaypee Brother Medical Publishers Pvt. Ltd; New Delhi; 2012; p425

2. Boericke William, Pocket Manual of homoeopathic Materia Medica & Repertory; B. Jain Publishers Pvt Ltd, new Delhi; 52nd Impression: 2012

3. https://emedicine.medscape.com/article/122393-overview

About the author

Reetesh Ratnakar Shet

Reetesh Ratnakar Shet

Dr. Reetesh Ratnakar Shet is in the Dept. of Practice of Medicine (PG part I)
A.M. Shaikh Homoeopathic Medical College PG Research Centre and Hospital, Belagavi. He is studying under the guidance of Prof. (Dr). Jyothi Vijaykumar, MD(Hom.) HOD, Dept of Practice of Medicine, A.M. Shaikh Homoeopathic Medical College PG Research Centre and Hospital, Belagavi.

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