Is Homoeopathy An Answer To Malabsorption Of Levothyroxine: A Case Series - homeopathy360
Articles

Is Homoeopathy An Answer To Malabsorption Of Levothyroxine: A Case Series

Abstract: Hypothyroid individuals are treated with Levothyroxine according to the standard protocol of American Thyroid Association. Often patients approach for homoeopathic treatment either with the complaint that their Thyroid function test do not come in normal range with the regular treatment with increasing doses of Levothyroxine or they experience array of signs and symptoms in spite of having Levothyroxine. It could be because of mal-absorption of Levothyroxine.  This article aims to show the result of homoeopathic treatment in such Levothyroxine dependent cases where in it is also suspected that there is mal-absorption of Levothyroxine

Keywords: hypothyroidism, Levothyroxine, elevated TSH, mal-absorption of Levothyroxine

Introduction: Hypothyroidism is relatively frequent in the clinical practise presenting with wide variety of clinical manifestation. According to the studies, prevalence of Hypothyroidism is found to be 1 in 10 adults in India (1) and globally as 9.5% (2). Sub-clinical and Anti-TPO positive hypothyroidism are commonly seen condition. Most of the study since ages have considered Levothyroxine (LT4) as the gold standard treatment for hypothyroidism (2) (3). One of the studies suggests that approximately 5% to 10% hypothyroid patients who have normal TSH complain about persistent symptoms despite receiving Levothyroxine treatment (4). The reason in such cases is attributed to Individual sensitivity, combined auto immune disease or AITD on its own, and inability of Levothyroxine to restore T4 Levothyroxine and Tri iodothyroxine concentration for a proper physiological absorption at the tissue level.There is another category of patients who suffer from signs & symptoms and show raised TSH in spite of increased calculated doses of Levothyroxine. A study shows a positive result with Levothyroxine but it also shows; around 1% of the study population had several reasons for higher doses of Levothyroxine.(7) It also suggests that patients on high doses of Levothyroxine may have an underlying absorption problem that should be evaluated. (7) The psychological well being of the such patients is also compromised.(6)

According to the literature, causes of persistently elevated thyroid-stimulating hormone in a patient on Levothyroxine replacement (5,8) are;

Inadequate Levothyroxine dosePoor patient compliance with medication Interaction with concomitant drugs Taking Levothyroxine with foodMal-absorption Interference with  laboratory assay due to heterophil antibodiesCoexisting thyroid hormone resistance (rare)

 Cause of such mal-absorption are mentioned in Table 1,     (9)

Causes of mal-absorption of Levo-thyroxine
Gastro-intestinal disorders– helicobacter Pylori infection, Celiac disease, lactose intolerance, pancreatic insufficiency & jejunum bypass surgery. Medications ferrous sulphate, calcium carbonate, aluminium hydroxide, sevelamer, sucrulfate and cholestyramine, anti epileptic drugs Food: large quantity of papaya, soy products, coffee or a fibre-rich diet 

Previous research study done in homoeopathy are suggestive of positive results in treating hypothyroidism in children (8 vk chauhan) one more study shows efficacy of Thyroidinum as adjuvant therapy in treating hypothyroidism. (9 adjuvant). Homoeopathic Materia Medica mentions specific action of Spongia as well Thyroidinum in treating hypothyroidism along with many polycrest homoeopathic medicines.(10clarke). The present study with the help of 5case, aims to show the efficacy of homoeopathy in cases of hypothyroidism with raised TSH despite of regular large doses of Levothyroxine.

Materials & method: Study of homoeopathic management of 5 cases of hypothyroidism who were previously on regular calculated doses of l-t4 was done. All 5 cases were of female patients with mean age of 36 years, lowest age being 21 years. Zulewski score for hypothyroidism was used to assess hypothyroidism. Change in TSH, tapered doses of L-T4 along with symptomatic relief was analysed.

Results: Homoeopathic constitutional medicines along with specific medicines (Spongia 30c and Thyroidinum 3x) were found to be prescribed which reduced and controlled the raised TSH. The L-T4 doses were tapered much lower than the previous doses. Patients did not have any further deterioration and was in better state of health. The Zulewski score for hypothyroidism was not found to be useful in all the cases except 2 in correlation to the raised TSH and clinical symptoms. The mean TSH improved to 4.28 from 25.86. (t=3.90, p<.05). The change in TSH and the change in L-T4 doses after homeopathic treatment are shown in Chart 1 & 2 respectively.

Chart 1: Change in TSH after homoeopathic treatment

Chart 2:

Findings of individual under the study are given in Table 2:

Name   Age Duration of L-T4 treatment(years) Duration of Homoeopathic treatment(months) Medicine prescribed Zulewski Score   before Zulewski Score   after
   XYZ-1 32 6 6 Carcinosin 1m 7 3
ABC-2 40 12 6 Nat mur 1m, Spongia 30 4 3
MNP-3 36 13 12 Sulphur 1m, Thyroidinum 3x, Spongia 30 3 2
SSZ-4 51 9 14 Ignatia 1M, Nat mur 1M, Thyroidinum 3x 6 3
HNM-5 21 4 14 Pulsatilla 1m, Cal carb 1m, Thyroidinum 3x 3 2

Discussion:

Hypothyroidism is a slow progressing disease effecting metabolism and growth with array of signs and symptoms. The patient dependent on Levo- thyroxine has to continue L-T4 medication for life long. It is a common understanding that the medicine for hypothyroidism once started should not be stopped without the advice of the physician. Often the patients are not having follow up at regular intervals and continue to have the 1st prescribed doses for long which may not be correct doses according to the T4 and TSH level. But there are patients who have regular follow up for their thyroid conditions and have compliance to the medication. Few may have mal-absorption because of which the TSH would remain high which is treated with intravenous doses of LT4.

In this case series all the 5 patients were having regular chronic medication with L-T4 for years. It was found that they had raised TSH even with patient compliance with regular intake of medicine. They did not have any other systemic disease or any other medication for any chronic illness other than one case who was being treated for psychiatric disease (schizophrenia,for 6months) No other cause was attributed for increased doses of L-T4 by the treating physician and so they started with homoeopathy medication. All the 5 patients improved symptomatically and L-T4 doses were tapered as TSH came under/near to normal range with homoeopathic treatment. All the patients reported improvement with tapered doses of L-T4. Since patients are still under treatment, there is scope of withdrawing L-T4. Medicines found useful as Constitutional remedy in 5 cases are Nat mur, Ignatia, Sulphur, Carcinosin, Pulsatilla & Calcarea Carb. Spongia and Thyroidinum 3x were given as specific thyroid remedy.

Scope of further research: The case series has limited number of individuals under study; hence a proper experimental research should be conducted in such hypothyroid condition. Since the treatment for pseudo-mal absorption of L-T4 is intravenous dose, which still not resolves the condition, action of homoeopathic medicine in better absorption of L-T4 should be verified.

References:

  1.  Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Unnikrishnan AG, Kalra S, Sahay RK, Bantwal G, John M, Tewari N. Indian J Endocr Metab [serial online] 2013 ;[cited 2020 Jul 14]; 17:647-52. Available from: http://www.ijem.in/text.asp?2013/17/4/647/113755
  2. The Colorado Thyroid Disease Prevalence StudyGay J. Canaris, MD, MSPHNeil R. Manowitz, PhDGilbert Mayor, MD; et alE. Chester Ridgway, MD .Arch Intern Med. 2000;160(4):526-534. doi:10.1001/archinte.160.4.526
  3. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement – Jacqueline JonklaasAntonio C. BiancoAndrew J. Bauer,Kenneth D. BurmanAnne R. CappolaFrancesco S. CeliDavid S. CooperBrian W. KimRobin P. PeetersM. Sara Rosenthal, and Anna M. Sawka
  4. An Online Survey of Hypothyroid Patients Demonstrates Prominent DissatisfactionSarah J. Peterson Anne R. Cappola M. Regina Castro Colin M. Dayan Alan P. Farwell James V. Hennessey Peter A. Kopp Douglas S. Ross Mary H. Samuels Anna M. Sawka,Peter N. Taylor,Jacqueline Jonklaas, and  Antonio C. Bianco.Published Online:1 Jun 2018https://doi.org/10.1089/thy.2017.0681
  5. Treatment for primary hypothyroidism: current approaches and future possibilities – Ali J ChakeraSimon HS Pearce, and Bijay Vaidya. Drug Des Devel Ther. 2012; Published online 2011 Dec 22. doi: 10.2147/DDDT.S12894, PMCID: PMC3267517,PMID: 22291465
  6. Psychological well-being in patients on ‘adequate’ doses of l-thyroxine: results of a large, controlled community-bases questionnaire study. Saravanan P, Chau W-F, Roberts N, Vedhara K, Greenwood R, Dayan CM:  Clin Endocrinol 2002, 57: 577–585. 10.1046/j.1365-2265.2002.01654.x
  7. Although 99% of patients are well treated, several factors contribute to high levothyroxine doses in primary hypothyroidism Clinical Thyroidology for the Public (from recent articles in Clinical Thyroidology) Volume 8 Issue 1 2015
  8. Noncompliance with medical treatment: pseudomalabsorption of levothyroxine Eledrisi MS, Szymajda A, Alshanti M, Urban RJ. Noncompliance with medical treatment: pseudomalabsorption of levothyroxine. South Med J. 2001;94:833–836.
  9. Levothyroxine pseudo-malabsorption: testing and treatment in the outpatient setting – Grzegorz M. Rdzak, Laura M. Whitman, and Silvio E. Inzucchi. Ther Adv Endocrinol Metab. 2018 Jul; 9(7): 217–222.ing.
  10. Efficacy of homeopathic intervention in subclinical hypothyroidism with or without autoimmune thyroiditis in children: an exploratory randomized control study.-Chauhan VKManchanda RKNarang AMarwaha RKArora SNagpal LVerma SKSreenivas V.
  11. Homoeopathic thyroidinum 3x–an adjuvant in the treatment of hypothyroidism- Kiruthiga S, Department of Homoeopathic Materia Medica, Bharati Vidyapeeth Homoeopathic Medical College, India
  12. Dictionary of Practical MATERIA MEDICA vol I, vol II, vol III – John Henry CLARKE 
SEEMA SUBRAMANIAN PILLAI
Author: SEEMA SUBRAMANIAN PILLAI

I am currently working as Thyroid Consultant at AIHMS Kochi.

Leave a Comment