Abstract : Hypothyroidism is a common endocrine disorder characterized by insufficient production of thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3), leading to a slowdown in metabolic processes. The condition can be classified as primary (due to thyroid gland dysfunction), secondary (resulting from pituitary dysfunction), or tertiary (caused by hypothalamic dysfunction). Common causes include autoimmune thyroiditis (Hashimoto’s thyroiditis), iodine deficiency, and post thyroidectomy or post-radioactive iodine therapy. Clinical manifestations vary but typically include fatigue, weight gain, cold intolerance, dry skin, constipation, depression, and bradycardia. Diagnosis is primarily based on elevated thyroid-stimulating hormone (TSH) levels with low T3 and T4 levels. Treatment involves lifelong thyroid hormone replacement therapy, most commonly with levothyroxine, tailored to maintain optimal hormone levels. Early diagnosis and management are crucial to preventing complications such as myxedema, cardiovascular diseases, and cognitive impairments. This review highlights the etiology, clinical features, diagnostic approaches, and treatment modalities of hypothyroidism, emphasizing the importance of individualized patient care.
Keywords : Hypothyroidism, Thyroidinum , Homeopathic medicine.
Introduction :
Hypothyroidism is a common endocrine disorder resulting from inadequate production of thyroid hormones, leading to a slowdown in metabolic functions. The thyroid gland, located in the anterior neck, plays a crucial role in regulating metabolism, growth, and development through the secretion of thyroxine (T4) and triiodothyronine (T3). When hormone levels fall below normal, various physiological processes are affected, resulting in symptoms such as fatigue, weight gain, cold intolerance, dry skin, constipation, and cognitive impairment.
The condition can be classified as primary hypothyroidism, which arises from intrinsic thyroid dysfunction (most commonly due to Hashimoto’s thyroiditis or iodine deficiency), or secondary/tertiary hypothyroidism, resulting from pituitary or hypothalamic disorders. Diagnosis is primarily based on laboratory findings, including elevated thyroid-stimulating hormone (TSH) levels with decreased free T4.
Eitology :
- Primary Hypothyroidism (Thyroid Gland Dysfunction)
This is the most common form of hypothyroidism and is caused by:
- Autoimmune Disorders
- Hashimoto’s Thyroiditis: The most common cause of hypothyroidism worldwide, characterized by autoimmune destruction of the thyroid gland, often associated with antithyroid peroxidase (TPO) and antithyroglobulin antibodies.
- Atrophic Thyroiditis: A severe form of Hashimoto’s thyroiditis with complete thyroid atrophy.
- Iodine-Related Causes
- Iodine Deficiency: Common in areas with low dietary iodine intake, leading to decreased thyroid hormone synthesis.
- Excess Iodine Intake (Wolff-Chaikoff Effect): Paradoxically, high iodine levels can inhibit thyroid hormone production.
- Post-Treatment Hypothyroidism
- Post-Thyroidectomy: Surgical removal of the thyroid gland (e.g., for thyroid cancer or goiter).
- Radioactive Iodine Therapy: Used for hyperthyroidism, can lead to permanent hypothyroidism.
- External Radiation Therapy: Radiation to the neck (e.g., for head and neck cancers) may damage the thyroid.
- Congenital Hypothyroidism
- Thyroid Agenesis or Dysgenesis: Absent or underdeveloped thyroid gland at birth. • Dyshormonogenesis: Genetic defects in thyroid hormone synthesis pathways.
- Drug-Induced Hypothyroidism
- Amiodarone: Contains high iodine content and can cause thyroid dysfunction. • Lithium: Inhibits thyroid hormone release.
- Antithyroid Drugs (e.g., Methimazole, Propylthiouracil): Used to treat hyperthyroidism but can induce hypothyroidism.
- Secondary Hypothyroidism (Pituitary Dysfunction)
- Caused by pituitary gland disorders leading to insufficient thyroid-stimulating hormone (TSH) production.
- Causes include:
- Pituitary tumors (adenomas)
- Pituitary surgery or radiation
- Sheehan’s syndrome (postpartum pituitary necrosis)
Symptoms :
Hypothyroidism affects multiple organ systems due to decreased thyroid hormone levels, leading to a slowdown in metabolism. The symptoms can vary in severity depending on the degree of hormone deficiency.
- General Symptoms:
- Fatigue (most common)
- Weight gain (despite normal diet)
- Cold intolerance
- Slow metabolism
- Dermatological Symptoms:
- Dry, rough, and pale skin
- Brittle nails
- Hair thinning or hair loss (including outer third of eyebrows – Hertoghe’s sign) • Myxedema (puffy face, periorbital swelling, non-pitting edema)
- Neurological Symptoms:
- Depression, mood swings
- Forgetfulness, poor concentration (“brain fog”)
- Slow reflexes
- Tingling or numbness (paresthesia)
- Cardiovascular Symptoms:
- Bradycardia (slow heart rate)
- Hypotension or hypertension
- Increased LDL cholesterol → Risk of atherosclerosis & heart disease
- Cold extremities (poor circulation)
- Gastrointestinal Symptoms:
- Constipation
- Slow digestion
- Loss of appetite but weight gain
- Musculoskeletal Symptoms:
- Muscle weakness
- Joint pain or stiffness
- Cramps and slow movement
- Reproductive Symptoms:
- Irregular or heavy menstrual cycles (menorrhagia)
- Infertility or difficulty conceiving
- Decreased libido
Management of Hypothyroidism :
The primary goal in managing hypothyroidism is to restore normal thyroid hormone levels, alleviate symptoms, and prevent complications. Management includes lifestyle modifications, medication, and regular monitoring.
- Pharmacological Treatment
- Thyroid Hormone Replacement Therapy
- Levothyroxine (LT4) (Synthetic T4) – First-line treatment
- Dosage:
- Adults: 1.6 mcg/kg/day (adjusted based on TSH levels)
- Elderly/CV patients: Start with a lower dose (25–50 mcg/day)
- Pregnant Women: Higher doses may be required
- Taken on an empty stomach, preferably in the morning, 30-60 minutes before food • Avoid taking with calcium, iron, or antacids (interfere with absorption)
- Liothyronine (T3) or Combination Therapy (T3+T4) – Used in rare cases (e.g., resistance to T4 therapy)
- Monitoring & Follow-Up
- TSH and Free T4 levels checked every 6–8 weeks after starting treatment • Once stabilized, monitor every 6–12 months
- Adjust dosage based on TSH levels, symptoms, and patient response
- Special Considerations
- Pregnancy:
- Increased levothyroxine dosage may be required
- Monitor TSH every 4–6 weeks
- Elderly & Cardiovascular Patients:
- Start with low doses to avoid cardiac complications
- Congenital Hypothyroidism:
- Early treatment (within first 2 weeks) is crucial to prevent mental retardation
- Lifestyle & Dietary Modifications
- Adequate Iodine Intake (through diet, if deficient)
- Avoid Goitrogens (excess soy, cruciferous vegetables in raw form)
- Regular Exercise to manage weight and prevent cardiovascular risks
- Manage Stress & Sleep to support thyroid function
- Management of Myxedema Crisis (Severe Hypothyroidism Emergency)
- IV Levothyroxine + Hydrocortisone
- ICU admission
- Supportive therapy (oxygen, temperature control, fluids) Thyroidinum – A Homeopathic Remedy
Thyroidinum is a Homeopathic Medicine : Derived from the thyroid gland of sheep. It is primarily used to treat conditions related to thyroid dysfunction, including hypothyroidism, obesity, goiter, and menstrual irregularities.
Key Indications of Thyroidinum:
- Hypothyroidism Symptoms:
- Fatigue, weakness, and sluggishness
- Weight gain despite reduced appetite
- Cold intolerance
- Dry skin and brittle hair
- Slow metabolism and constipation
- Obesity & Metabolic Disorders:
- Helps regulate slow metabolism
- Used in cases of unexplained weight gain
- Goiter & Thyroid Swelling:
- Effective in reducing enlarged thyroid glands
- Helps in nodular goiter and thyroid dysfunction
- Menstrual & Reproductive Disorders:
- Irregular or heavy menstruation (menorrhagia)
- Delayed puberty or hormonal imbalances
- Helps in polycystic ovary syndrome (PCOS) associated with thyroid issues
- Mental & Nervous System Issues:
- Depression, irritability, or mood swings
- Poor concentration (“brain fog”)
- Memory weakness and lack of confidence.
Common Potencies & Dosage:
- 3X, 6X, 30C are commonly used.
- Low potencies (3X/6X) are used when physical symptoms dominate. • 30C or higher may be used when emotional or systemic symptoms are present.
Case History : 48 year old female patient suffering from hypothyroidism from 2-3 years , along with increase sensitivity towards noise.
Past History : patient having history of hysterctomy and tuberculosis.
Family History : patient having family history of hypertension.
Physical General :
Appetide – decrease
Thirst – normal
Perspiration – decrease
Desire – salty
Sleep – disturbed
Thermal – chilly
Obese female
Mental General :
Talkative
Weeping tendency
Irritability
Dullness and slowness of mind
General Examination :
BP – 120/70 mmHg
PR – 72/min
RR – 12/min
Tongue – clear
Skin – dry
Analysis & Evaluation –
| MENTAL GENERAL | PHYSICAL GENERAL | PARTICULAR |
| SLOWNESS OF MIND | CHILLY | THYROID FUNCTION DISTURBED |
| DULLNESS OF MIND | APPETIDE DECREASE | HISTORY OF HYSTERCTOMY |
| IRRITABILITY | OBESE | SKIN – DRY |
Evaluation Of Symptoms –
SLOWNESS AND DULLNESS OF MIND
IRRIABILITY
CHILLY PATIENT
OBESE
APPETIDE DECREASE
THYROID FUNCTION DISTURBED
HISTORY OF HYSTERCTOMY
Miasmatic diagnosis –
Psoro – sycotic
Selection of Repertory – Synthesis Repertory by Dr. Frederik Schroyens.
Software used – Synthesis App 1.3 (v.135)
Repertorial Totality –
| Remedy
Thyroidinum Calcarea carb. Graphites Lycopodium Baryta carb. Phosphorus Natrum mur. |
Rubrics Matched Rubrics Matched Miasmatic Tone | Psoric ↔ Sycotic (intercurrent) Strongly Psoric
Psoric + Sycotic Predominantly Sycotic Syphilitic (nodular stage) Syphilitic (atrophic stage) Psoric with emotional dryness |
|
| 5 / 9 | 1, 2, 3, 4, 5 | ||
| 4 / 9 | 1, 2, 3, 4 | ||
| 4 / 9 | 2, 3, 4, 5 | ||
| 4 / 9 | 3, 5, 6, 7 | ||
| 3 / 9 | 5, 6, 9 | ||
| 3 / 9 | 3, 8, 9 | ||
| 3 / 9 | 1, 2, 3 |
Repertorial Analysis –
Thyroidinum – 5/9
Calcarea Carb – 4/9
Graphites – 4/9
Baryta carb – 3/9
Selection of Remedy – Thyroidinum :selected on the basis of totality of symptoms and reportorial result. But final selection depends upon the materia medica.
Prescription – Thyroidinum 3X
3tab early morning for 15 days
Follow ups –
| Date | symptoms | Follow up |
| 19/03/23 | Patient is improved | Placebo BD 15 days |
| 15/06/23 | Symptoms are relapsed | Thyroidinum 3X 15 days |
| 12/12/23 | Patient is better than before | Placebo 15 days |
| 14/04/24 | Patient is improved | Placebo 15 days |
Discussion – In case of hypothyroidism, thyroidinum is very effective.
Conclusion – The case shows the positive effect of homeopathic constitutional medicine selected on the basis of totality of symptoms in case of hypothyroidism.
References –
Keynotes and Characteristics with Comparisons. B. Jain Publishers.
https://www.bjainbooks.com/product/keynotes-and-characteristics-with-comparisons/ 3. Clarke, John Henry.
1.A Dictionary of Practical Materia Medica. B. Jain Publishers (3 Vols).
https://www.bjainbooks.com/product/a-dictionary-of-practical-materia-medica-3-vols-set/ 4. Thyroidinum – Boericke’s Materia Medica (Online)
https://www.vithoulkas.com/learning-tools/materia-medica-boericke/thyroidinum-boericke/ 5. Thyroidinum – Clarke’s Materia Medica (Online Full Text)
https://materiamedica.info/en/materia-medica/john-henry-clarke/thyroidinum 6. Thyroidinum – YouTube Lecture (Dr. Nikunj Jani)
https://www.youtube.com/watch?v=_bNbAKAviv4
https://www.mheducation.com/highered/product/harrison-s-principles-internal-medicine-vol-1-vol 2-jameson-fauci/M9781259644030.html
- Ralston, Stuart H., et al.
Davidson’s Principles and Practice of Medicine. 24th Edition. Elsevier.
https://www.elsevierhealth.in/davidson-s-principles-and-practice-of-medicine-international-edition 9780702070273.html
- American Thyroid Association (ATA) Guidelines
https://www.thyroid.org/professionals/ata-professional-guidelines/
- National Institute for Health and Care Excellence (NICE) – NG145
Thyroid disease: assessment and management
https://www.nice.org.uk/guidance/ng145
- Mayo Clinic – Hypothyroidism Overview
https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284
About the Autor:
Dr. Dakshta Choubey – MD Scholar in homeopathic materia medica department
Dr. Shobhana Shukla head of department of homeopathic materia medica
