Role of Homoeopathic Management in Hypothyroidism

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

2. 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 [1^st 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 I^st 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 5^th month

PHYSICAL GENERALS:

• Desire: Sweet⁺²; warm food preferred⁺¹
• Aversion: Milk⁺²
• Intolerance: Sour food & drinks causes burning in stomach
• Stool: D_1-2; N_0; 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. (18^th). 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.