Clinical Cases

Role of Homoeopathic Management in Hypothyroidism

The authors discuss hypothyroidism and present a case to illustrate. Fear of narrow places, thinks people are talking about her and frightful dreams were among the symptoms leading to the simillimum.

 

INTRODUCTION:

Hypothyroidism denotes deficient production of thyroid hormone by the thyroid gland & can be primary (abnormality in thyroid gland itself) or secondary/ central (as a result of hypothalamic or pituitary disease). Primary Hypothyroidism is the etiology in approximately 99% of cases of Hypothyroidism. [2] Hypothyroidism is characterized by a generalized reduction in metabolic function that most often manifests as a slowing of physical & mental activity. [3]

The prevalence of Hypothyroidism in the developed world is about 4-5%. The prevalence of subclinical Hypothyroidism in the developed world is 4-15%. [4] Hypothyroidism is more prevalent in women who have four to ten time’s greater likelihood of developing than men. The female: male ratio is approximately 6:1. The risk is higher in postpartum period & during menopause after which the risk increase with age. [1]

CASE STUDY:

A 46 years old married Hindu female having fair complexion and of middle socio-economic status, reported in outpatient department (OPD), with complaint of irregular menses since 2 years. She was also complaining of burning pain in b/l soles from 4 months.

Irregular menstrual cycles since 2 years

LMP: 25/03/21

Duration: 4-5 days

Cycle: 25-60 days

Quantity: Profuse

Fluid in consistency, but sometime clots present

  1. Burning pain in b/l soles since 4 months

Location: B/L soles (Foot)

Sensation: Burning sensation

Modality: < – Afternoon, > – Cold application

HISTORY OF PRESENT COMPLAINTS:

Patient was apparently well 2 years ago when she gradually had complaint of irregular menses. She took allopathic treatment for this with temporary relief. Now since 4 months the patient is experiencing burning pain in b/l soles. First it was only in afternoon but now persists throughout the day. She applied ointment and cold application for temporary relief.

PAST HISTORY:

Diseases/Operation/Injuries etc. Age/year in which occurred Treatment taken       Outcome
Chickenguniya 2 years ago Took allopathic treatment          Relief

 

FAMILY HISTORY:

Father – Alive & H/o HTN; DM                           Mother- alive & healthy

 GYNECOLOGICAL & OBSTETRICS HISTORY:   

Gynecological History:

  • Menarche/ Menopause (age): Menarche – 15 years of age
  • LMP [1st day of last menstruation]: 25/03/2021
  • Menstruation:

Duration: 4-5 days       Quantity: Profuse

Cycle (interval): 25-60 days          Color: red/dark red/dark: Bright red

Consistency: fluid/clotted/partly fluid & partly clotted: Fluid but sometime

clots present

Pattern of bleeding: regular/irregular: Irregular

  • Any associated complaint(s): Pain in lower abdomen at Ist day of menses.
  • Any other vaginal discharge: Thin, watery discharge from vagina < – before menses

  Obstetrical History:

  • GPAL (Gravida, Parity, Abortion and Live births): G3 P2 A1 L2
  • Major complications during past pregnancies: Miscarriage at 5th month

PHYSICAL GENERALS:

  • Desire: Sweet+2; warm food preferred+1
  • Aversion: Milk+2
  • Intolerance: Sour food & drinks causes burning in stomach
  • Stool: D1-2; N0; unsatisfactory stool, hard stool with mild straining.
  • Perspiration: Diminished, non-offensive; non-staining
  • Thermal Reaction: Towards Chilly
  • Sleep & Positions: Refreshing; 7-8 hr./day; lying on abdomen & b/l side

MENTAL GENERALS:

  • Fear of being alone; of narrower places as if she would be suffocated+2; of ghosts+1 (darkness)
  • Anxious about own health +3 at little trifles
  • She has desire for company
  • Weakness of memory
  • She thinks other people are talking about her+2
  • Dreams frightful+2

GENERAL EXAMINATION:

  • General appearance: Fair complexion & flabby
  • Facies: No swelling present
  • Skin/hair/nails: Skin is dry & rough to touch
  • Weight: 89 kg
  • BMI: 30.1kg/m2

 LOCAL EXAMINATION – EXAMINATION OF THYROID GLAND

Observation
Grading [as per WHO grading (0,1,2)] 0 grade
Inspection Shape normal, no swelling present
Palpation Temperature normal, No tenderness, trachea normal
Auscultation No abnormal sound heard
Any other information Nothing significant

LABORATORY INVESTIGATIONS:

Previous Investigations and reports
Done – 16/04/2021

T3 – 1.08 ng/ml

T4 – 8.21 µg/dl

TSH- 48.22 µIU/ml

 ANALYSIS OF SYMPTOMS:

          Mental Generals      Physical Generals               Particulars
Fear of being alone; of narrower places as if she would be suffocated+2 ;  of ghosts (darkness)

Anxious about own’s health+3 at little trifles

She has desire for company

Weakness of memory

She thinks other people talking about her+2

Dreams of frightful+2

Desire: Sweet+2; warm food preferred

Aversion: Milk+2

Sour food & drinks causes burning in stomach

Stool: D1-2; N0; unsatisfactory stool, hard stool with mild straining

Perspiration: Diminished

Thermal reaction: Towards  Chilly

 

Menses irregular and profuse in quantity

Burning pain in b/l soles

Mod. < – Afternoon,  > – Cold application

 EVALUATION OF SYMPTOMS:

  1. Anxious about own health+3 at little trifles
  2. Fear of being alone
  3. Fear of narrower places as if she would be suffocated+2
  4. She thinks other people are talking about her+2
  5. Dreams frightful+2
  6. Desire of Sweet+2
  7. Aversion to Milk+2
  8. Menses irregular and profuse in quantity
  9. Burning pain in b/l soles

TOTALITY OF SYMPTOMS:

  1. Anxious about own’s health +3 at little trifles
  2. Fear of narrower places as if she would be suffocated+2
  3. She thinks other people are talking about her+1
  4. Dreams frightful+2
  5. Desire of Sweet+2
  6. Aversion to Milk+2
  7. Burning pain in b/l soles
  8. Menses irregular and profuse in quantity

REPERTORIAL METHOD:

Repertorization was done from Synthesis repertory [Source: Schroyens, Frederik. Synthesis Repertorium Homoeopathicum Syntheticum 5.2 Ed. New Delhi: B. Jain Publishers (P) Ltd; 1993]

 

REPERTORIAL ANALYSIS:

S.no. Remedies and their relative values
1.

2.

3.

4.

5.

Calcarea Carbonicum –  20/9

Pulsatilla – 19/9

Sulphur – 19/9

Sepia – 15/9

Silicea – 15/9

JUSTIFICATION OF MEDICINE:

Calcarea carbonica is the remedy selected in this case as it covers all the rubrics and obtains highest marks in repertorisation. Calcarea carbonica covers the other physical generals also.  Calcarea carbonica in 200CH potency is selected in this case according to the susceptibility.

FIRST PRESCIPTION:

      RX  Calcarea Carb 200/1 dose

Rubrum 30/TDS was given on 21/4/2021

       ZULEWSKI’S CLINICAL SCORE [5]: 9  (Pre Score)

FOLLOW- UP:

 

Date

 

Changes in Symptomatology

 

Prescription

6/05/2021

 

 

 

LMP: 25/03/21

Menses profuse and irregular

Burning pain in b/l soles slightly better

Constipation better

Burning in stomach slight better from previous days

RX  Rubrum 30/TDS x 15 days

 

 

18/05/2021

 

 

 

LMP: 10/05/2021

Menses profuse and partly fluid and partly clotted bleeding, bright red color bleeding

Constipation better, no straining during defecation

Burning pain in b/l soles much better

Rx

        Rubrum 30/TDS x 15 days

 

 

2/06/2021

 

LMP: 10/05/2021

Constipation better , no difficulty during defecation

Burning pain in b/l soles much better from previous days

Burning in stomach sometime after eating sour foods

Rx

       Rubrum 30/TDS x 15 days

 

 

 

 

15/06/2021 LMP: 14/06/2021

Menses profuse and consistency is fluid

Pain in lower abdomen at first day of menses is reduced from last menses

Constipation not present

Patient feel much better in burning pain in b/l soles

 

Rx

Rubrum 30/TDS x 15 days

30/06/2021 LMP: 14/06/2021

Constipation reappeared since 8 days, hard stool with great straining during defecation

Burning in b/l soles is still persist

Rx

      Calc carb 200/1 dose

Rubrum 30/TDS x 15 days

16/07/2021 LMP: 14/06/2021

Constipation much better after administration of medicine, soft stool without straining during defecation

Burning in stomach not present from previous days after eating of sour foods and drinks.

Patient feel burning in b/l soles sometime

Advised Thyroid Profile (TFTs)

Rx

Rubrum 30/TDS x 15 days

29/07/2021 LMP: 18/07/2021

Menses normal in quantity, no pain feel in lower abdomen at first day of menses, consistency is fluid and menses regular,

Burning pain in b/l soles not present

Constipation not present,  bowel movements are regular

Investigation done – (23/07/2021)

TSH: 4.29µIU/ml

Zulewski’s Clinical Score: 3

Rx    Rubrum 30/TDS x 15 days

 

 

INVESTIGATION & SCORE REPORT: (PRE & POST TREATMENT)

 CONCLUSION:

From this study it can be concluded that individualized homoeopathic medicines are helpful in reducing Zulewski’s Clinical Score, Serum TSH level and improved quality of life in cases of hypothyroidism. Homoeopathic management has shown tremendous results in cases of hypothyroidism. There was a pause in the progress of the disease and reduction in the severity and frequency of the complaints thus improving quality of life and preventing any further complications.

REFERENCES:

  1. Longo D, Fauci A, Kasper D, Hauser S, Jameson J. Harrison’s Principles of Internal Medicine. (18th). US: McGraw-Hill Professional; 2012.
  2. Kumar P, Khandelwal D, Mittal S, Dutta D, Kalra S, Katiyar P,et al. Knowledge, awareness, practices and adherence to treatment of patients with primary hypothyroidism in Delhi. Indian J Endocr Metab. 2017; 21: 429-33.
  3. Bello F, Bakari AG. Hypothyroidism in adults: A review and recent advances in management. Journal of Diabetes and Endocrinology. 2012; 3(5): 57-69.
  4. Chandey M, Kaur R, Mohan G, Mannan R. Prevalence of hypothyroidism in adults by screening TSH: a study from North India. Int J Adv. Med. 2016; 3: 44-6.
  5. Zulewski’s H, Müller B, Exer P, Miserez AR, Staub J. J. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. The Journal of clinical endocrinology and metabolism. 1997 82(3): 771–776. https://doi.org/10.1210/jcem.82.3. 3810.

About the author

Jagdish Thebar

Jagdish Thebar Professor & HoD, Practice of Medicine, Swasthya Kalyan Homoeopathic Medical College & Research Centre. Jaipur, India.

About the author

Anshul Chahar

M.D.(Hom.), Associate Professor, Department of Practice of Medicine, Swasthya Kalyan Homoeopathic Medical College & Research Centre, Sitapura, Jaipur, Rajasthan, India

About the author

Namrata Nandwana

M.D. (PGR), Department of Practice of Medicine, Swasthya Kalyan Homoeopathic Medical College & Research Centre, Sitapura, Jaipur, Rajasthan, India

1 Comment

  • Not a very scientific article as the use of Rubin is not explained at all anywhere but used for the patient to take daily

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