Objective: The aim of this observational study on 116 patients of PSH is to understand the bio-psycho-social significance in its etiology. Also, to know what is the outcome of homeopathic treatment (Classical way) in these cases?
Methods: The methodology followed was as per the Organon of Medicine by Dr. Samuel Hahnemann. The levels of TSH value (before and after treatment) were taken as criteria of result, apart from clinical improvement. Data analyzed to research standards using SSPS, ANOVA, Epi Info sofwares etc.
Results: The psycho-social factors like grief, insult, etc. emerged (now-a-days psycho-social epidemic) as the key factors in etiology of PSH (p=0.019). With the homoeopathic treatment, 54.47% patients were relieved up to level 4 (Similimum: transformation of the patient physically, mentally, spiritually). The most effective remedies found were Ignatia and Staphisagria (p=0.000). On comparison of TSH value before and after homoeopathic treatment has shown marked improvement (p=0.000). The correlation of before and after homoeopathic treatment was also found significant as p value was found 0.000.
Conclusion: In summary, based on our results, bio-psycho-social perspective indicated that psycho-social issues like grief and insult most likely affect the thyroid of females more than males. Patients of PSH have shown significant results with similimum to achieve cure up to the level 4. PSH patients, if treated with homeopathy, can be saved to be patients of overt disease.
Keywords: Thyroid, Primary Subclinical Hypothyroidism, TSH, Aphorism, Homoeopathic Treatment, Ignatia and Staphisagria, psycho-neuro-immunology (PNI).
Thomas Wharton who named the gland as thyroid meaning shield as its shape resembled like a shield. Thyroid hormone in lower vertebrates is concerned with growth, development, and reproduction. Earlier, this organ was a pelvic organ but gradually it moved up and now in humans it is placed in the throat with the functions extended to growth and development of mind too. In human the fetal thyroid becomes active at the 10th week of gestation.
Primary Sub-clinical Hypothyroidism is an encapsulated stage of hypothyroidism. So, subclinical means a latent state which comes years before the overt disease- hypothyroidism. Deranged vital force expresses itself with the latent signs and symptoms of thyroid, demands constitutional treatment only.PSH is a common problem with a prevalence of 3% to 8% in the population without known thyroid disease, increases with age and is higher in women. After the sixth decade of life the prevalence in men approaches that of women, with a combined prevalence of 10%. Most important implication is high likelihood of progression to clinical hypothyroidism.
Signs and Symptoms: When the latent symptoms, as mentioned below are observed, advice the patient TFT & TPO antibody tests. In the presence of normal T4 level, TSH is higher than normal even after 2 tests, 6 weeks apart indicate illness. In such cases it is very important to get the anamnesis done so that the cause of the diseases can be found out.
Constitutional symptoms: Gets tired more easily or has low level of energy than before, sensitive to temperature changes, especially cold. Muscles/joints may become painful or difficult to lift. Despite maintaining a healthy diet and exercising, may find unexplained weight gain, also, face appear bloated and puffy. Some exhibit elevated cholesterol levels in the blood.
Skin, hair or nail symptoms: Skin dry, flaky, pale or yellowish appearance. Hair and nails may become dry, brittle, causing break easily.
Psychological Symptoms: May develop depression, feeling tired, irritable, restless or disinterested in your activities.
Female-Specific Symptoms – Decrease thyroid hormone levels may cause you to experience exceptionally heavy menstrual periods.
The aim of this observational study on 116 patients of PSH is to understand the bio-psycho-social significance in etiology of primary sub-clinical hypothyroidism. Also, to know what is the outcome of homoeopathic treatment (Classical way) in these cases?
Case selection: Cases of PSH, who consulted me, were undertaken.
Inclusion criteria: Diagnosed cases with TSH up to 28µU/ml and undiagnosed cases were included irrespective of their age, sex, caste, religion and duration of the illness.
Exclusion criteria: Cases without follow-up were excluded from the study.
Diagnostic criteria: Level of TSH was conducted before and after homoeopathic treatment.
Case taking proforma: Standardized case taking proforma was created following the guidelines as given Aphorism 5, Aphorism 6, Aphorism7, Aphorism 82-Aphorism 104.
· Case Perceiving: During the case perceiving the stress is on the anamnesis of the case to know the bio-psycho-social cause of it.
· Analysis and Evaluation : It was done according to the case as-
ü At the patient level, i.e., understanding the patient who has hypothyroidism including its various constitutional signs & symptoms which must cover up holistically.
· Selection of Remedy (Aphorism 153) – Remedy should be selected on the following basis-
ü To the patient as a person or seeing whole through the hole (regional remedies). Selection of medicine must have in-built concept of miasm (homoeopathic etiology) by understanding presenting complaints with encapsulated past of the patient. At the medicine level,i.e., understanding the medicine – which should cover hypothyroidism firstly the well known medicines (extensively proved) but if not indicated lesser known medicines (need extensively proving). They can be prescribed as either patient as a person or as intercurrents to set-in reaction.
· Selection of Potency (Aphorism 279), and Dose – Homoeopathic medicine in Centesimal and Fifty Millisemal potencies were prescribed to the patients. Selection of the dose means potency (P), Quantity (Q) & Repetition (R).
ü Potency should be decided according to the understanding of pathology & susceptibility (aphorism 279).
ü Quantity of the medicine & repetition of the medicine should be decided according to: Nature of medicinal substances, Physical constitution of patient, Magnitude of his disease (aphorism 246 FN).
· Follow-up: It includes either the selection of next suitable medicine as the rules of second prescription. If the case shows improvement then the follow-up should be –General to Particular – case either follows HERING’S LAW then sit on the remedy. If there is no progressive improvement then follow relationship of medicine. If the case is not improving or is worse than before then check the whole case either at the patient level, doctor level, quality/ dispensing of medicine, and then act accordingly.
· AssessmentCriteria: This is as follows –
ü Level 4: Similimum: transformation of the patient physically, mentally, spiritually;
ü Level 3: Simile: disappearance of the disease with lasting quality of life;
ü Level 2: disappearance or removal of the symptoms;
ü Level 1: no healing or palliative care.
2. Not Relieved
· Data Analysis: The related clinical data will be collected and analyzed to research standards according to type of data using different methods of analysis applicable, i.e., SSPS, ANOVA, Epi Info software etc.
Analysis according to the Gender: From the data (Refer Graph 1 ) we could observe that the PSH found to occur in both males and females but it was observed that the number of patients who consulted majority of them were female patients. It can be observed from the result of the analysis that out of 116cases who reported 90 were females and 26 were males. Result revealed that out of 116cases 54 patients were relieved.
Analysis According To Age Group:We could observe that although the disease was prevalent from age 10 to 75years but the maximum number of patients who reported were from the middle age group. It can be observed from the result of the analysis that in the age group of 31-40years out of 41cases 24 were relieved, followed by the age group 26-30 years where out of 12cases,7 were relieved and then in the age group of 61-65 where out of 9 patients 4 were relieved. Result revealed that out of 116cases 54 patients were relieved.
Analysis of the cause of PSH: From the data (Refer Graph 2 ) we can conclude that the patient is affected by various factors such as familial, environmental, various emotional factors such as anger, grief, insult, etc.
Analysis according to the potency prescribed: : From the data (Refer Graph 3 ) we can see, in all the 116 cases various potencies such as 6C, 30C, 200C, LM1 were prescribed and it was observed that the maximum number of patients were relieved by the use of fifty millisemal potency followed by the 200C potency.
Analysis according to the Dose Prescribed: From the above (Refer Graph 4 ) table we can observe that out of 116 patient 50 patients were given frequent doses, 22 were relieved by giving frequent doses followed by prescription of single doses in 24 cases where 9 were relieved and then by small doses where out of 9 cases 8 were relieved.
Analysis of the Outcome of the study: From the data (Graph 5 at P.5) we can see that an observational study was done on 116 cases and the outcome of the study revealed that 54.47% patients were relieved up to level 4 after taking homoeopathic similimum.
Analysis according to the remedy prescribed: In all the 116 cases which consulted a homoeopathic similimum medicine according to the case was prescribed. It was seen that the remedy which was mostly prescribed is Ignatiaamara which gave relief to 21 cases followed by Staphisagria which relieved 7cases and then Thujaoccidentalis, Causticum, Arsenic album which relieved 4 cases each.
Many studies done on the cases of PSH have shown the gender sensitivity of this disease as females are more vulnerable than males but in later age after sixty as such no gender sensitivity. The age is next significant factor where middle aged from 31 to 40 years females is getting this disease most. And as far as the cause was concerned, it remained idiopathic. In other system treatment is generally either wait-and-watch or if anti TPO antibodies are positive then have treatment for lifelong. In some studies done with homoeopathic treatment has shown remarkable positive results.
Our study revealed that so far as the gender and age was concerned, it remained consistent with other studies. This study has shown that the psycho-social issues like anger, grief and insult became the important causative factors behind the occurrence of PSH. This psycho-social cause has become an epidemic so much so that the children of 10 to 15 years started having this disease, which is a concern. Recently, the concept of psycho-neuro-immunology (PNI)8has stresses a lot of these psycho-social factors as reasons of various diseases.
The result of homeopathic treatment has shown relief up to level 4, i.e., transformation of patient, physically, mentally, spiritually, in more than 50% of patients. Here, two most important medicines those have shown the result is Ignatia and Staphisagria. Indication of both medicine shows many symptoms of PHS. The potencies found effective were LM and 200 in repeated doses.TSH levels of these patients were compared before and after the indicated remedy, which were found within normal limits.
There are several limitations to the present study and result should be interpreted with caution. It was an observational study in respect of PSH so far treated. Our sample size was very small. In the diagnostic criteria, Anti TPO antibodies should be done with TSH levels.
In summary, based on our results, bio-psycho-social perspective indicated that psycho-social issues like Grief and Insult most likely affect the Thyroid of females as compared to males. Patients of PSH have great scope to be treated with similimum to achieve cure up to the level 4. As such when these patients have no answer anywhere, if treated with homeopathy they can be saved to be patients of overt disease.
1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664572/accesed on 5/1/14.
2. L.M.Khan. (2004). Pleasure Of Prescribing By L.M. Khan. delhi: B. Jain Publishers Pvt. Ltd, 1921/10, Chuna Mandi, Paharganj, New Delhi, DL 110055.
3.R.E.Dudgeon. (2007). Organon of Medicine. New Delhi: Indian books & Periodicals Publishers, Block-5/62, Dev Nagar, Pyare Lal Road,Karol Bagh, New Delhi-119995(India).
4.Warrell. (2010). Oxford Textboook of Medicine (5th ed.). Oxford ; New York: Oxford University Press.
5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743364/accesed on 10/1/14
6. https://www.clinicalkey.com/topics/endocrinology/hypothyroidism.htmlaccesed on 20/1/14.
7.http://archinte.jamanetwork.com/article.aspx?articleid=613119#Referencesaccesed on 22/4/14
8.Ader, R. (2001). Psychoneuroimmunology (Third ed.). california: Academic Press, A Harcourt Science and Technology Company.