Case Study Analysis of Hypothyroidism and its Homoeopathic Intervention

Homeopathic Perspective of Lifestyle diseases- With Focus on a Case Study Analysis of Hypothyroidism and its Homoeopathic Intervention

Background:

We are today living on the top of a volcano of health problems in the form of lifestyle diseases. These are chronic & non-communicable diseases (NCDs) observed worldwide with near life-threatening consequences & increased death rates in the population.  With increased modernization, the prevalence of NCDs has increased, and the quality of life has been affected. Most countries are facing this problem 

Methodology:

Data collected from patients visiting OPD and IPD patients who had received conventional levothyroxine treatment, were intervened with Homoeopathic medicines using randomized sampling method. Statistical data analyzed using IBM SPSS 25.0 Version software Chi2 test applied for quantitative data analysis of 60 cases.

Results: Comparative Effectiveness of Two Treatments In the present study was analyzed.

Statistically significant results (P<0.05) that Homeopathic therapy improved both health status and subjective well being in patients

Group A: Constitutional remedy based on the totality of symptoms

Out of 30 cases treated, 24 cases improved, 6 did not improve.

 Group B: Specific remedies Thyroidinum 6X

Out of 30 Cases treated, 16 cases improved, 14 did not improve

Conclusion:

Homoeopathic medicines are well tolerated, helps improve appetite, improves the immune system bringing a positive difference in physical, cognitive, social and emotional functioning. Providing a holistic healing with a sense of well-being.

Key words: Lifestyle, Epigenetic, Environmental, Hypothyroidism, holistic.

Introduction: 

Lifestyle diseases are the major health issues linked to one’s lifestyle. The following are lifestyle diseases 

• Atherosclerosis
• Heart disease
•  Stroke
• Obesity 
• Type 2 Diabetes mellitus
•  Respiratory ailment 
• Thyroid disorders
•  Cancer²

The Following are risk factors of lifestyle Diseases/Ncds 

• High stress levels
• Lack of physical activity, restricted movement for prolonged hours
• Poor / little sleep
• undesirable behavior 
• Smoking, drinking, drug abuse, addictions, social media. 
• Exposure to pollutants at work or home
• Habits that cause direct damage to the body  (earphones, poor seating)
• Iodine intake, deficiency such as Vitamin D & Selenium, infections & certain drugs (estrogens) 
•  Unhealthy eating habits –plenty of processed food with little or no nutritive value & lack of hydration.³

Hypothyroidism Is defined as low thyroxine due to failure of thyroid gland to produce sufficient thyroid hormone 

• It’s a hormone responsible for essential body functions like regulates metabolism, heart rate and energy levels.
• An underactive thyroid slows down the body’s metabolism resulting in weight gain. 
• it raises thyroid receptor cell resistance  and impair the immune system⁴
• Autoimmune thyroid disease is the most common cause for hypothyroidism
• Autoimmune thyroiditis (AIT) is increasingly identified in children.
•  AIT may manifest as Euthyroid, Subclinical hypothyroidism (SCH) or overt hypothyroidism (OH). 
• The prevalence increases with age, and is higher in females than in males.

Need for Study :

• The relationship between lifestyle & environmental factors influencing development of thyroid dysfunction seems paradoxical.⁵

Interestingly, recent studies have indicated that environmental and lifestyle factors may interact with genetic factors by influencing epigenetic mechanisms, such as altering DNA methylation and chromatin modifications, thereby modulating gene expression.⁵

 It is found that even at subclinical level, hyperthyroidism and hypothyroidism are associated with overall reduction of medical well-being. Hence it’s a prime need to explore the broader  landscape to the insight of this problem. 

Aims and Objectives.

1: To assess the influence of lifestyle factors in hypothyroidism

2: To compare the efficacy of Homeopathic intervention with constitutional medicine and Specific Thyroidinum 6x in hypothyroidism

Methodology:

 Study Design 

• The study was a prospective single blind comparative randomized assessment conducted using data from patients visiting Dr MRMC hospital. The patients who had secondary   hypothyroidism   were excluded. All the patients signed informed consent. Each case was dealt in detail including h/o present & past illness, family & personal history, general and systemic examination keeping in view homeopathic perspective of case taking. 
• The collected data was statistically analyzed for significance; within the grouping Student’s paired T test. In between the groups, the means were compared using Independent Samples.
•   Unpaired T test was performed manually to analyze the comparative effectiveness of the two treatments.
• These tests were performed using SPSS 25.0 version software. 
•  Ethical approval was accorded by duly constituted ethical committee 
•  Majority of patients in study were polysymptomatic: tiredness, lethargy, hair fall, delayed menses, weight gain etc were seen.
•  Purposive sampling included 60 cases of Hypothyroidism with Group A and Group B, comprising 30 cases each.

Investigations

• The best laboratory assessment of thyroid function, for diagnosing primary hypothyroidism, is serum TSH test.
• If the serum TSH level is elevated, testing should be repeated with a serum free thyroxine (T4) measurement
• An elevated serum TSH level with a normal range serum free T4 level is consistent with subclinical hypothyroidism.
• TSH level higher than 4.22 mIU/L was defined as hypothyroidism (including subclinical hypothyroidism).
• Overt primary hypothyroidism is indicated with an elevated serum TSH level and a low serum free T4 level. 
• A low serum free T4 level with a low, or inappropriately normal, serum TSH level is consistent with secondary hypothyroidism evidence of hypothalamic-pituitary insufficiency. 

Management 

       Conservative 

• Do not modify or stop the conventional treatment without consultation.
• increase dietary iodine intake
• iron rich foods, fruits dark green leafy veg 

Preventive

• Levels of prevention of thyroid disorders: 
• Stage i –primordial prevention 
• Stage ii-primary prevention 
• Stage iii secondary, tertiary prevention 

Primordial Prevention

• Health promotion:
• Educate the family regarding lifestyle measures, good food habits, positive attitude to be inculcated in young child
• Specific protection:
• Regular exercise
• Desirable BMI
• Health promotive measures and attitude
• Identifications and elimination of exciting or precipitating factors, if any

Primary Prevention

• Early diagnosis and treatment.
• Reinforce primary and preventive measures
• Identifications and elimination of exciting or precipitating factors, if any.

Secondary Prevention

• Aggressive reinforcement of:
• Primary and secondary risk intervention.
• Secondary prevention: lipid profile within normal limit.
• Aggressive and effective control of disease

Plan of Treatment: 

•  Group A: Constitutional remedy to base on the totality of symptoms
  Group B: specific remedy Thyroidinum 6X 

Understanding relationship between Endocrinology and Homoeopathy” from H. A. Roberts:

 The modern physiologist’s viewpoint is that vast amounts of illness are traceable to dysfunctions of the glandular system. E.g., Growth problems (overgrowth or underdevelopment of the whole body or parts).

 Human beings are a unit made up of mind, body and spirit. They are co-related, so as to act freely, without impediment, when the ‘spirit like vital force’ or ‘dynamis’ is in equilibrium.
Association of thyroid dysfunction with these disorders makes the condition what we read in Organon as “Complex diseases”. The treatment plan of these diseases is done according to the laws embedded in Organon of Medicine. (Aphorism 3)

Homeopathic Treatment:

 The aim of homoeopathic treatment is to stimulate the body’s homeostatic mechanism. In order to achieve this, we have to give the right similimum at the right time.  In Homoeopathy, we treat the disease not by supplementing the deficiency, but by stimulating the function of thyroid gland effectively which acts on the body at the level of immunity.
Thus Homeopathy has the potential to treat SCH with or without TPO Ab and can also prevent progression to overt hypothyroidism (OH).

Results:

• The study using multivariable logistic regression analysis, showed stress, obesity, Insomnia, Smoking, Alcohol consumption, have higher incidence of hypothyroidism.
• Exercise, weight watch was associated with decreased incidence of hypothyroidism.
• Regular physical activity may be protective.
• People with hypothyroidism positive forTPOAb had higher BMI, HR, and HDL levels.
• Comparative Effectiveness of Two Treatments In the present study was analyzed.
  Group A: 30 cases treated, 24 cases improved, 6 did not improve.
  Group B: 30 cases treated, 16 cases improved, 14 did not improve. 
• The difference in proportion was found to be statistically significant. (P<0.05).
• Statistically, constitutional remedy is more significant (P<0.05) in treatment of hypothyroidism(80%) compared to Thyroidinum 6X as a specific remedy (53%).

 The null hypothesis is thus rejected.

Understanding relationship between Endocrinology and Homoeopathy from H. A. Roberts:

 The modern physiologist’s viewpoint is that vast amounts of illness are traceable to dysfunctions of the glandular system. E.g., Growth problems (overgrowth or underdevelopment of the whole body or parts).

 Human beings are a unit made up of mind, body and spirit. They are co-related, so as to act freely, without impediment, when the ‘spirit like vital force’ or ‘dynamis’ is in equilibrium.
Association of thyroid dysfunction with these disorders makes the condition what we read in Organon as “Complex diseases”.The treatment plan of these diseases is done according to the laws embedded in Organon of Medicine. (Aphorism 3)

Homeopathic Medicines Used:

Case Report 1 (19-7-2021)
A female aged 15 years presents with painful swelling in the throat since 2 years (thyroid gland) moves on deglutition. She also has hair fall, acne and an oily face. She was under thyroid hormone supplement on a daily basis for 1 year but when the thyroid profile showed normal results, she stopped hormone supplement intake herself without any expert opinion. Subsequently her complaints reappeared and she came to consultation at the OPD, She had anxiety about her complaints.

Patient had a history of measles at 8 yrs, at 10 yrs skin allergy. 12 yrs she stated chronic constipation & swelling in the neck which was treated with conventional medicine
Family history revealed nothing except allergic rhinitis in her father.
Menstrual history revealed she has irregular, late menses since menarche (FMP-11yrs, LMP-06/05/2021)
Duration and quantity of bleeding is normal
Feels sad during menses. She has a fear of expressing emotions especially with loved ones because she might be rejected by them so she never has a habit of revealing the matters, yet there was no history of any rejection in reality.
She also has a fear of worms, she has a craving for salt, milk and sweets. Patient is thermally hot.
On local examination she had Grade 3 swelling: Thyroid swelling visible without hyper extended neck.
Considering the above symptomatology, medicine was selected after repertorization

Rubrics

FEMALE- MENSES- late.
FEMALE- MENSES-SADNESS during
GENERALITIES- FOOD and drinks-milk desires.
GENERALITIES- FOOD and drinks-salt or salty food – desires.
GENERALITIES- FOOD and drinks-sweets- desires
EXTERNAL THROAT-SWELLING-Thyroid Gland.
FACE-GREASY.
FACE-ERUPTION-acne. 

Prescription :

 19-7-2021: Natrum mur 200/3D (1D stat and 2D s.o.s);

Follow up:

2/08/2021 : symptoms persisting placebo for 15 days.

16/08/2021: Thyroid gland enlargement persists as same, anxiety reduced, amenorrhea, acne with oily face and hair fall persists placebo for 15 days.

30/08/2021: Thyroid gland enlargement persists as same, anxiety reduced, amenorrhea persists, acne with oily face and hair fall slightly reduced, Generals: Normal NATRUM MURIATICUM 200/ 3D Review after 30 days

27/09/2021: Menses appeared on 21/09/2021, duration-5 days, normal bleeding, no clots, thyroid gland enlargement persists as same, anxiety reduced, sadness feeling popped with onset of menses
Acne with oily face slightly better, TSH level reduced to 4.96µIU/ml Placebo prescribed for 15 days

11/10/2021: Patient is improving and hair fall better.  : Menses regular, acne with oily face reduced, anxiety reduced, acne reduced, thyroid swelling slightly reduced persists
Placebo prescribed for 15 days

date	T3(0.60-1.81)microGrams/Ml	T4(3.5-12.06)microGrams/Dl	TSH(0.35-4.94)microIU/Ml	Thyroid med
20-6-2019	1.89	8.9	2.57	Euthyrox 25 mcg
03-08-2020	1.23	110.65	19.23	Euthyrox 50 mcg
03-04-2021	1.23	94.60	15.45	Euthyrox 50 mcg
14-9-2021	0.04	61.87	4.96	Homoe +Euthyrox 25 mcg
12-12-2021	1.02	50.26	3.57	Homoe +Thyronorm 12.5mcg
21-5-2022	1.45	109.76	3.12	Homoe +Thyronorm 12.5mcg
21-09-2023	3.29	103.87	2.26	Homoe +Thyronorm 12.5mcg

• The present study was an amalgamation of the use of a constitutional and  specific remedy .Study adopted a pragmatic exploration approach.

Summary

Treating lifestyle diseases is both time-consuming and expensive. Though most of the lifestyle diseases seems incurable yet can be controlled and prevented if proper nutrition and necessary changes are made in the lifestyle intervened by medicines

These case study analyses of hypothyroidism  found that maintaining a healthy lifestyle, early and accurate diagnosis,  most appropriate selection of Homeopathic remedies ,adhering to the prescribe medical treatment plan and follow-up is important for cure of hypothyroidism. 

 Positive associations between different lifestyle factors and the incidence of different thyroid diseases could be found. Statistically, constitutional remedy is more significant (P<0.05) in treatment of hypothyroidism compared to Thyroidinum 6X as specific remedy.

 Homeopathy has the potential to treat SCH with or without anti TPO Ab and can also prevent progression to overt hypothyroidism (OH). The aim of homoeopathic treatment is to stimulate the body’s homeostatic mechanism. 

References

1. Harrison’s Principles of Internal Medicine, 18th Edition by Dan L. Longo, Anthony S. Fauci, Dennis L. Kasper and Stephen L. Hauser, (published by McGraw-Hill Education), 2011.
2. Dorr M, Volzke H. Cardiovascular morbidity and mortality in thyroid dysfunction. Minerva Endocrinol. 2005;30(4):199–216. [PubMed] [Google Scholar]
3. Davidson’s Principles and Practice of Medicine International Edition, 22nd Edition by Brian Walker & Nicki R Colledge & Stuart Ralston & Ian Penman, 2014

        4.     Wiersinga WM. Clinical relevance of environmental factors in the pathogenesis of autoimmune thyroid disease. Endocrinal Metab (Seoul) 2016;31(2):213–222. [PMC free article] [PubMed] [Google Scholar]

        5.     Alegria-Torres JA, Baccarelli A, Bollati V. Epigenetics and lifestyle. Epigenomics. 2011;3(3):267–277. [PMC free article] [PubMed] [Google Scholar 

          6.   Hahnemanns organon of medicine by B.K.Sarkar, Birla publications Pvt. Ltd.

Author

Dr Nayeem unnisa Begum. MD (Homoeo)

 Professor, pg guide and head department of practice of medicine

 Hkes Dr Maalakaraddy Homeopathic medical college and hospital kalaburagi Karnataka