Clinical Cases

Hypothyroidism in a Woman of 30

Hypothyroidism

PRELIMINARY DATA

Date of visit: 17/8/18

Patients Name: Mrs. M.S

Age: 30 Years /Female

Status: Married

Religion: Hindu

Occupation: House wife

PRESENTING COMPLAINTS

℅  Headache (Vertex) since last 9 yrs

℅ Small swelling over chin bilaterally (1 on each side ) since last 4-5 years

℅  puffiness of face and swelling of full body x last   4-5 years

℅   Numbness of both hands, even after working a little since last 4-5 years

DETAILS OF PRESENTING COMPLAINTS

℅  Headache (Vertex) since last 9 yrs

H/o Fall from bike- sustained injury to occiput

Sensation – as if heat is coming out of vertex the last few years

Headache > applying Oil, Vicks

< stress

No nausea, no vomiting, no photophobia. No aura (visual/Sensory) before

headache.

 

℅ Small swelling over chin bilaterally (1 on each side) since  last 4-5 years, size: 2 x 1cms / each side),  No tenderness.

hard swelling (+) Left side of chin, Not movable.

hard swelling (+) Right side of chin, movable.

Previously same complaints were present – was excised (sample -sent for

histopathological examination – reported as benign swelling).

 

℅ Puffiness of face and swelling of full body since last 4-5 years, Puffiness

throughout the day.

 

℅  Numbness of both hands, even after working a little since last 4-5 years

Swelling of inter phalangeal joints of both hands, Non tender.

No modalities

No tenderness, no warmth, no restriction of movements.

PAST HISTORY

Sr. No Age condition Treatment taken
1. 25 yrs Umbilical Hernia Repaired
2. 26 yrs Nodular swellings over Chin Excised

PHYSICAL CHARACTERISTICS

Build- obese

Hair- Hair loss + , No dandruff, No greying

Nails –  No pallor, No Paronychia

Face – Symmetrical and expressive, puffiness

Appetite- good

Diet- Mixed

Craving – Nothing significant

Aversion- Nothing significant

Thirst- 2 lit/day

Stool once /day semisolid satisfactory Non offensive
Perspiration Localised on neck No peculiar odour Non-Staining
Urine 4-5 times/day Pale yellow Can control No dysuria

MENSTRUAL FUNCTION

Menarche-12 yrs
LMP- 12.8.18
Menses:

Duration- 3-4 days

Cycle-regular

Flow- moderate

Clots – Absent

Odour- No peculiar odour

Concomitant: Before- Pain in lower

abdomen

During: Pain present

After- No complaints

Leucorrhoea : Before menses, thin albuminous, for 2-3 day

PREGNANCY, LABOUR, PUERPERIUM

G2 P2 L2 A0
Male 11yrs
Male 6 yrs

LIFE SPACE

Patient lives in a nuclear family. Patient doesn’t want to share her feeling with anyone, will share only with her husband. Doesn’t want to mix easily, doesn’t talk much, since childhood. Doesn’t want to go out of house, wants to stay at home. Needs company of husband whenever she goes out of the house. Speed of her household work is slow, but she does it perfectly and systematically and completes it on time. Wants to do only routine work; if she does any extra work she feels exhausted.

The last 2-3 years she cannot remember things; forgets where she has kept things; remembers only after 2-3 hours.

Patient studied till VIII std. Before marriage used to work in a shop where she did calculations, but now she finds it difficult to calculate. She wants to teach her children, but cannot do so. She says her mind doesn’t work, cannot understand.

Dreams: of Snakes in forest, going on its own way, but becomes fearful by looking at them; gets up frightened from sleep.

Fear: To go out of the house when it’s dark.

THERMAL STATE- Chilly patient

COVERING Summer- thin winter-thick Rainy- thick
BATH Summer- Cold Winter- Warm Rainy- Warm
FAN summer-Fast winter-slow Rainy- slow

GENERAL EXAMINATION

Eyes- No pallor, No icterus

Tongue- Clean , Macroglossia

Nails- No pallor

Lymph node- submandibular, submental, pre and post auricular, cervical lymph nodes not palpable

Neck: No restricted movements in cervical spine. Lhermitte sign- negative

Oedema- No periorbital swelling, Non pitting pedal oedema.

VITALS : T: 98 F  Pulse- 73b/m    RR- 15 resp/m   BP- 120/84 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

DIAGNOSIS

Subclinical hypothyroidism (Homeopathy for Hypothyroidism)

TOTALITY OF SYMPTOMS

  • Doesn’t want to share her feelings.
  • Doesn’t want to talk much.
  • Desires Company of husband.
  • Weakness of memory.
  • Exhausted feeling.
  • Cannot understand.
  • Fear of dark.
  • Swelling over chin.
  • Puffiness of face.
  • Swelling of whole body.
  • Numbness of both hands.
  • Swelling of inter phalangeal joints.
  • Headache –vertex .
  • Chilly patient.

REPORTORIAL RESULT

Hypothyroidism in a Woman of 30 1

REMEDY/PRESCRIPTION  (date: 17/8/18)

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

FIRST FOLLOW UP: 19.09.2018

Investigation Done By Patient  In Morning Before Starting First Prescription : 18.08.2018

TEST RESULT REFERENCE RANGE
FBSL 102 mg/dl  (70-105 mg/dl)
Hb 13.7 gm/dl Male :13.5-17.5gmm/dl

Female: 12.0-15.5 gm/dl

Serum creatinine 0.8 mg/dl 0.5 – 1.1 mg/dl
Blood urea 24 mg/dl (14 – 40 mg/dl)
TSH 30.43 uIU/ml (0.3– 5.5 uIU/ml )
T3 80 ng/dl (60 — 200 ng/dl)
T4 5.4ug/dl (4.5-12 ug/dl)

Repertorisation after seeing investigation Report during  first  follow-up

Hypothyroidism in a Woman of 30 2

FIRST FOLLOW UP: 19.09.2018

     SYMPTOMS INTERPRETATION PRESCRIPTION
     ℅   small swelling over chin bilaterally SQ 1. Calc carb  0/1

1 tbsp / OD x 15

Days

 

After 15 days

 

2.  Calc carb 0/2

1 tbsp / OD x 15

days

     Puffiness of face and swelling of full body >>
    Numbness of both hands, even after doing little work Increased
     Swelling of interphalangeal joints of both hands > 100%
      Headache (Vertex)

Sensation – as if heat is coming out of vertex

Headache > Applying Oil , Vicks

> 20%
     App – Good

Thirst- 2 litre/day

Urine, Stools – No complaints

     LOCAL EXAMINATION – CHIN

Inspection: post surgical scar present over chin

palpation  : hard swelling (+) Left side of chin

Non movable, non tender.

hard swelling (+) Right side

of chin

Movable, non tender.

Second Follow up: 02.11.2018

SYMPTOMS INTERPRETATION PRESCRIPTION
℅  swelling  over chin bilaterally >35% Rubrum 30

3–3–3 x 1 month

 Puffiness of face and swelling of full body >>
Swelling of interphalangeal joints of both hands. > 100%
     Headache (Vertex)

Sensation – as if heat is coming out of vertex.

> 40%
     App – Good               Thirst- 2 litre/day

Urine, Stools – No complaints

     Mind: Increased sexual desire, wants to get

intimate with husband daily.

(started after

Calc carb 0/2)

Third Follow up: 01/12/18 – Sat

SYMPTOMS INTERPRETATION PRESCRIPTION
℅  swelling  over chin bilaterally > 40% Rubrum 30

3–3–3 x 1 month

     Puffiness of face and swelling of full body SQ
     Headache (Vertex)

Sensation – as if heat is coming out of vertex

Absent
    App – Good      Thirst- 2 litre/day

Urine, Stools – No complaints     Sleep – good

Weight – 58kg

THYROID EXAMINATION

No visible swelling

No visible swelling on act  of swallowing

Thyroid gland not palpable.

   MIND:  Very sensitive, thinks over past,

Needs Husband every time.

    VITALS

P- 63 b/min ; BP- 110/70 mmHg

RR- 14 respiration/min

Fourth Follow Up: 05/01/2019 – Sat

SYMPTOMS INTERPRETATION PRESCRIPTION
℅  swelling  over chin bilaterally > / SQ 1.  Belladona 200

3–3–3 x 2 days

2.  Rubrum 200

3–3–3 x 1 month

 

3. Belladona 1M / sos

(½ dram)

3pills to be taken if

Headache is not

Ameliorated with

Belladonna 200

 ℅  Puffiness of face and swelling of  full body >10 %
℅   Headache -aggravated x 2 days

A/F- stress

Sensation – as if heat is coming out of vertex

when she touches the scalp

<<
App – Good

Thirst- 2- 3 litre/day

Urine, Stools – No complaints

Sleep – good

Weight – 58kg

THYROID PROFILE 1  (Shows during 4th Follow up)

Hypothyroidism in a Woman of 30 3

7.12.18
T3 87 ng/dl 60-200
T4 6.1ug/dl 4.5-12
TSH 19.69 u IU/ml 0.3-5.5

Fifth  Follow Up : 02/02/2019 ; Sat

SYMPTOMS INTERPRETATION PRESCRIPTION
℅  swelling  over chin bilaterally

(1x1cms on each side)

> 50%  Calc carb 0/3

1 tbsp / OD x 15 days

Rubrum 300

3–3–3 x 1 month

 ℅ Puffiness of face and swelling of

full body

>30 %
℅ Headache Absent
App – Good

Thirst- thirsty

Urine, Stools – No complaints

Sleep – good

Weight – 58kg

Sixth  Follow Up : 02/03/2019 ; Sat

SYMPTOMS INTERPRETATION PRESCRIPTION
℅  swelling  over chin

bilaterally

> 70% Calc carb  0/4

1 tbsp / OD

x 15 days

 

Rubrum 30

3–3–3 x 1 month

 ℅ Puffiness of face and

swelling of full body

> 60 %
 App – Good

Thirst- thirsty

Urine, Stools – No complaints

Sleep – good

Seventh  Follow Up : 06/04/2019 ; SAT

SYMPTOMS INTERPRETATION PRESCRIPTION
℅  swelling  over chin

bilaterally

> 80% Calc carb 0/5

1 tbsp /OD

x 15 days

 

Rubrum 30

3—3–3 x 15 Days

 

Calc carb 0/6

1 tbsp /OD

x 15 days

 ℅ Puffiness of face and

swelling of full body

> 80 %
 App – Good

Thirst- thirsty

Urine, Stools – No complaints

Sleep – good

Weight – 57kg

THYROID PROFILE  ( DATED : 15.4.19 )

Hypothyroidism in a Woman of 30 4

15.4.2019
T3 81 ng/dl 60-200 ng/dl
T4 5.9 ug/dl 4.5-12 ug/dl
TSH 5.86 u IU/ml 0.3-5.5u IU/ml

 

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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