ABSTRACT Objective- Hashimoto’s Thyroiditis is a common autoimmune disorder that can be associated with hypothyroidism or goitre. Conventional treatment for Hashimoto thyroiditis consists of administering a medicine that replaces lost thyroid hormone monotherapy with levothyroxin. The disease modification of The most common known adverse reactions associated with excessive consumption of Levothyroxin are chest pain, tachycardia, irregular heart rhythm, swelling in your legs, ankles, or feet, and dyspnea. In conventional medicine, there is only lifelong replacement therapy. Homeopathic medicine for Hashimoto’s thyroiditis modifies the immune system and treats symptoms to aid in the management of hormonal fluctuations. improves general wellbeing, or Quality of Life (QoL), However, in addition to reducing clinical and pathological symptoms, homoeopathic medicine provides a better response in Hashimoto’s thyroiditis, which is an autoimmune disease, even though it is not a lifelong therapy.
Methods: A young woman with Hashimoto’s thyroiditis presents with symptoms, and the patient’s levels of anti-thyroglobulin antibodies and antithyroid peroxidase antibodies are elevated. The patient has been thoroughly evaluated and treated with constitutional homoeopathic medicine over a variable period of time. Thyroid-stimulating hormone, anti-thyroglobulin antibodies, and antithyroid peroxidase antibody levels were measured.
Results: To see the improvement in the autoimmune disorder by homoeopathy dynamic dilution, a significant improvement in the clinical symptoms of Hashimoto’s thyroiditis, as well as the pathological reports was observed. 2-8-20 Anti TGA – 187.50 IU/ml, Anti TPO – 331 IU/ml and thyroid – uneven and slightly coarse thyroid in USG, indicating she had Hashimoto’s thyroiditis. Homeopathic medicine Cuprum Metallicum 1x has recovered clinical symptoms and Anti TGA – 12.17 IU/ml Anti TPO – 25.20 IU/ml TSH – 3.28 μU/ml on 27-3-21 with an emphasis on restoring the disease’s secondary effects, such as hypothyroidism and restoration of all clinical symptoms .
CONCLUSION: This case study demonstrates the most effectiveness of constitutional homoeopathic intervention in the treatment of Hashimoto’s thyroiditis (autoimmune disorder).
KEYWORDS – ANTI THYROGLOBULIN ANTIBODIES, ANTI THYROID PEROXIDASE, HASHIMOTO’S THYROIDITIS, HOMOEOPATHY
INTRODUCTION- Hashimoto thyroiditis is an autoimmune disorder in which immune system cells damage the thyroid gland as a result of a misguided response. 1 T and B lymphocytes that are reactive to thyroid antigens infiltrate the thyroid gland first. Activated B cells secrete thyroid autoantibodies. Because thyroiditis is an autoimmune disease, thyroid peroxidase is the most important antibody directed against thyroid tissue (Anti TPO Ab). 2 Although elevated Anti TPO Ab is frequently associated with it, Cytotoxic T lymphocytes are the primary cause of thyroid parenchyma destruction. Cytological features include follicular cell Hurtle cell changes as well as an increase in mature and transformed lymphocytes impinging on follicular cells. 3Follicular architecture is eventually destroyed, and fibrosis and thyroid enlargement take its place to varying degrees. 4 It’s a condition known as chronic lymphocytic thyroiditis. The precise cause of Hashimoto’s thyroiditis is unknown; however, risk factors include hypothyroidism, iodine deficiency, medication, infection, smoking, stress, and other factors.5 Hashimoto’s thyroiditis causes a slew of symptoms. Some of the most common symptoms include fatigue, weight gain, a pale or puffy face, a cold feeling, joint and muscle pain, constipation, dry and thinning hair, heavy menstrual flow or irregular periods, depression, panic disorder, a slowed heart rate, and difficulties getting pregnant and maintaining pregnancy. Hashimoto’s disease affects seven times more women than men. It can strike teenagers and young women, but it is more prevalent in middle age, particularly among men. 6 It has a chance of turning into cancer, the most common of which are extranodal marginal B cell lymphoma and papillary carcinoma of the thyroid. It’s also a highrisk population for breast cancer. 7 early detection and treatment of Hashimoto’s thyroiditis is essential to avoid future complications. A case study published in 2014 found that a homoeopathic intervention reduced serum TSH levels and antiTPO antibody titers in children with subclinical hypothyroidism and/or autoimmune thyroiditis. According to the findings, homoeopathic treatment for autoimmune thyroid disorders may indeed be effective. 8 The following case report demonstrates how homoeopathic medicine can effectively manage Hashimoto thyroiditis and lower serum TSH, anti-TPO, and antiTGA antibody titers, demonstrating the holistic concept of homoeopathy.
Case report-On July 30, 2020, a 28-year-old female patient was registered to the outpatient department. For the past six months, the patient has had reddish macular eruptions on his face, along with anxiety and palpitations. She also complained of cramping pain and weakness in both lower limbs, particularly the calf muscles, which worsened at night, as well as throat pain. This was a known case of Hashimoto thyroiditis for which the patient had been receiving allopathic treatment for the previous three months.
Past History -She received homoeopathic treatment for PCOS two years ago and has since recovered.
Family History-The mother suffers from hypothyroidism and hypertension, while the father has vitiligo. Both siblings are in good health.
Mental Generals-She was anxious whenever rashes appeared on her face and became irritable over trivial matters. She enjoys having company and is afraid of being alone. She had a sharp mind and a strong memory.
Physical Generals-She eats well and has regular bowel movements. Her thirst was as it should be. She has a sweet cravings and a milk intolerance, which causes digestive problems and sometimes diarrhoea. Sleep was unrefreshing and disturbed. The urine was a light yellow colour. The patient had a chilly thermal response.
Menstrual History-She has a 30-35 day menstrual cycle that lasts 2-3 days, the discharge is bright red with normal flow, mildly offensive, and she has no other symptoms during menses other than minor lower abdominal pain.
Local Examination-No visible swelling of the gland noticed.
Investigations-Anti-thyroglobulin antibodies – TGA – 8.40 IU/ml, anti-thyroid peroxidase TPO – 159.37 IU/ml, and normal TSH levels were observed in a blood test on March 19, 2020.
REPORT DATED 19/3/20: TSH, ANTI TPO AND ANTI TGA ANTIBODIES TITERS –FIG 1
PRESCRIPTION AND OUTCOME DATE 30-07-2020 However, due to a history of allopathic medications, detox effects of hormonal medication according to A Text-book Of Materia Medica and Therapeutics. Characteristic, Analytical, And Comparative Allen Corson Cowperthwaite 9 Nux-vomica 200C stat was prescribed along with Sac lac 30 C twice a day for 3days during the first visit and Patient educate about Diet and Regimen -Gluten free diet and high protein and laxatives, High fiber diet likes Fish, Whey protein, flax seed, chia seed, spirula, almonds, nuts, coconut milk, Advice do current investigation- Anti Thyroglobulin Antibody,Anti Thyroid peroxidase, Thyroid profile ,Ultrasound Throat etc.
SECOND PRESCRIPTION 2-08-20
Report Dated 1-08-20: USG Thyroid _ Fig 2
Report Dated 01-08-2020: ANTI TPO and ANTI TGA Antibodies Titers –Fig 3
Anxious on being alone.
Anxiety whenever the rashes on the face appear.
Intolerance to milk which often disturbs digestion
Reddish eruptions on face
Pain in throat
Cramping pain in calves aggravated at night
Weakness in lower extremities
MIASMATIC DISSECTION – Psora –Syco-Syphilitic Miasm-explanation Syphilitic miasm -autoimmune disease, Psora miasm –history of allergic, Sycotic miasm – Polycystic ovary, hormones secretion increase.10Following a thorough case taking, the totality of the symptoms listed below was further repertorised using a complete repertory from homepath software.11
HOMOEOPATHIC INTERVENTION- Based on repertorisation, Cuprum Metallicum was selected as the appropriate homoeopathic medicine. Cuprum Metallicum are covering all of the repertorial totality’s symptoms rubrics and miasm even After consulting materia medica12 where only Cuprum Metallicum had the symptom “pain in thyroid cartilage ,12and confirm by ultrasound throat . Hashimoto thyroiditis would show totally physical and specific symptoms. according to potency detector tool 13 we would select right at the physical and specific end of the ‘physical-mental’ axis and ‘specific-general’ axis, on our chart meaning that although it’s a very physical condition the degree of generality could indicate a 6c, 30c or it would be higher if the patient was this way by nature! We select lower potency.
REPERTORIAL TOTALITY AND RESULT FROM COMPLETE REPERTORY FIG 4
PRESCRIPTION AND OUTCOME DATE 02-08-2020-Following the first prescription of Nux-vomica 200C/1dose, Cuprum Metallicum 1X/HS for 6 days was prescribed. The patient was only given Cuprum Metallicum after that, and she reported that her symptoms had improved. The medicine’s potency was not changed, and the prescription was repeated as needed when the patient’s condition improved.
Prescription and Follow Up at Different Intervals _Table 1
Report Dated 17-08-20: TSH, ANTI TPO and ANTI TGA Antibodies Titers – Fig-5
Report Dated 3-9-20: TSH, ANTI TPO and ANTI TGA Antibodies Titers-Fig -6
Report Dated 29-9-20: TSH, ANTI TPO and ANTI TGA Antibodies Titers- Fig 7
Report Dated 29-10-20: TSH, ANTI TPO and ANTI TGA Antibodies Titers- Fig -8
Report Dated 26-11-2020: TSH, ANTI TPO and ANTI TGA Antibodies Titers- Fig – 9
Report Dated 28-12-20: TSH, ANTI TPO and ANTI TGA Antibodies Titers – Fig- 10
Report Dated 24-03-2021: TSH, ANTI TPO and ANTI TGA Antibodies Titers – Fig- 11
RESULT- In our study, the Anti Thyroglobulin Antibody, Anti Thyroid Peroxidase, and Thyroid Profile were enhanced than normal range in starting of treatment 2-8-20 Anti TGA – 187.50 IU/ml ,Anti TPO – 331 IU/ml but Normal TSH, T3 and T4 levels.USG thyroid – uneven and slightly coarse thyroid, indicating she had Hashimoto’s thyroiditis. Homeopathic medicine Cuprum Metallicum 1x has recovered clinical symptoms and Anti TGA – 12.17 IU/ml Anti TPO – 25.20 IU/ml TSH – 3.28 μU/ml on 27-3-21 with an emphasis on restoring the disease’s secondary effects, such as hypothyroidism and restoration of face roughness with calf muscle pain, as well as restoring strength due to calf muscle pain to help with the neuromuscular and musculoskeletal. . The Anti Thyroglobulin Antibody, Anti Thyroid Peroxidase, and Thyroid Profile were shown in tabular and graphical form after her medication dosage was changed. Shows tabular form in Table-2 and graphical form shown in fig. 12.
TSH, TPO, TGA -REPOT IN TABULAR FORM- TABLE 2
TSH, TPO, and TGA -REPOT IN GRAPHICAL FORM- FIG 12
DISCUSSION: Indication, i.e., symptom, is the only weapon in our hand to treat diseases. During drug proving, we find numerous symptoms of a particular drug; amongst them, there are few characteristics and rare symptoms which represent the medicine as a whole which are termed keynote symptoms or ‘prognostic factors’ by the modern homoeopathic researchers. We should look for those symptoms in patients and match with that of medicine consulting repertory if required. The first prescription was done on the basis of prolonged use of allopathic medications i.e.; Nux-vomica 200C /1 dose for detox of hormonal effects.9 After it, the remedies Cuprum Metallicum 1x were prescribed. The selection of Cuprum Metallicum was done on the basis of covered all the reportorial rubrics, miasm and only remedy to cover the main presenting complaint of the patient i.e.; pain in cartilage of thyroid gland.12,13 The potency selection of the remedies was low as the case has more specific and physical symptoms than general and mental symptoms according to potency detector tool.14 The follow up has been taken at proper intervals as per the need of the case and investigations also been advised accordingly. The levels of anti-thyroglobulin antibodies, anti-thyroid peroxidase and thyroid titers has been assessed from time to time to check the progress of the case which has come within normal limits after successful treatment with homoeopathy. Within 3 months the patient has shown marked improvement in her complaints as well as general well-being.
CONCLUSION:A statistically significant decline in serum Anti TGA ,Anti TP, TSH values and it titers indicates that the homeopathic intervention has not only the potential to treat clinical symptoms but may also restore thyroid hormones and prevent to degenerative changes in thyroid disease . Homoeopathy is based on the principle of individualization and proves to be beneficial in managing the autoimmune diseases without any complications
The patient was treated with homoeopathic medicines after thorough case taking and repertorisation with the help of materia medica. This case report suggests that homoeopathic treatment can be done in the cases of autoimmune thyroid disorders without hesitation. Homoeopathy helped in alleviating the symptoms of the disease as well as provided clinical evidence of normalizing the levels of Thyroid stimulating hormone, Anti-thyroglobulin antibodies and Antithyroid peroxidase antibody with due course of time.TSH, Anti TPO AND Anti TGA reports. After unsatisfactory outcome with modern medicine, patient turned to homoeopathic treatment. After detailed case taking and repertorization with the help of materia medica., Cuprum Metallicum was given in low potency Within 3–4 months of homoeopathic treatment, the patient started improving and Finally, constitutional homoeopathic dynamised dilutions were effect tive in treating autoimmune disease and capable of treating th e diseases neuromuscular, musculoskeletal impairments caused by hypothyroidism. Aimed at restoring strength provides
clinical evidence and pathological reports demonstrating that symptoms were improved and successfully treated medicinesThere is limited research on Homoeopathic therapy to treat Hashimoto’s thyroiditis; however. Homoeopathy is based on the principle of individualization and has been shown to be effective in the treatment of autoimmune diseases without any complications. This case report suggests that homoeopathic treatment can be done in the cases of autoimmune thyroid disorders without hesitation.
Conflict of Interest-None declared
Acknowledgment -The authors are grateful to Dr. Bindu Sharma, Assistant Director (H), CCRH (Hqrs), New Delhi, for guidance.
Author Contributions- Dr Mrs Neeraj Gupta – Recording of the case and data collection.
Dr Surabhi Khatta – Literature search and preparation of the article.
Both the authors reviewed and approved the final article.
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Rathi, Monika et al. “Cytomorphological Aspects of Hashimoto’s Thyroiditis: Our Experience at a Tertiary Center.” Clinical medicine insights. Pathology vol. 7 1-5. 16 Jan. 2014, doi:10.4137/CPath.S13580
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FIG 1- REPORT DATED 19/3/20: TSH, ANTI TPO AND ANTI TGA ANTIBODIES TITERS
FIG 2- REPORT DATED 1-08-20: USG THYROID
FIG 3- REPORT DATED 01-08-2020: ANTI TPO AND ANTI TGA ANTIBODIES TITERS
FIG 4 – REPERTORIAL TOTALITY AND RESULT FROM COMPLETE REPERTORY
FIG 5- REPORT DATED 17-08-20: TSH, ANTI TPO AND ANTI TGA ANTIBODIES TITERS
FIG 6- REPORT DATED 3-9-20: TSH, ANTI TPO AND ANTI TGA ANTIBODIES TITERS
FIG 7 -REPORT DATED 29-9-20: TSH, ANTI TPO AND ANTI TGA ANTIBODIES TITERS
FIG 8- REPORT DATED 29-10-20: TSH, ANTI TPO AND ANTI TGA ANTIBODIES TITERS
FIG 9- REPORT DATED 26-11-2020: TSH, ANTI TPO AND ANTI TGA ANTIBODIES TITERS
FIG 10- REPORT DATED 28-12-20: TSH, ANTI TPO AND ANTI TGA ANTIBODIES TITERS
FIG 11-REPORT DATED 24-03-2021: TSH, ANTI TPO AND ANTI TGA ANTIBODIES TITERS
FIG 12 – TSH, TPO, TGA -REPOT IN GRAPHICAL FORM
TABLE 1- PRESCRIPTION AND FOLLOW UP AT DIFFERENT INTERVALS
TABLE 2- TSH, TPO, TGA -REPOT IN TABULAR FORM