Management of Hypothyroidism through Homoeopathic Medicinal Intervention

Management of Hypothyroidism through Homoeopathic Medicinal Intervention

ABSTRACT: Homoeopathy   is  a system of medicine   based  on   individualization  and   symptom similarity of the patient. It treats every person as a whole and individualised entity. The homoeopathic literature is caring   various examples of thyroid diseases and their treatment aspects  with homoeopathy. There are numerous examples of clinical and therapeutic studies done on thyroid disorders but there are few peer reviewed controlled design studies in Homoeopathy. Homoepathic medicines play an important role in immuno  modulation  at the cellular level and   can   manage  cases   of   hypothyroidism.

INTRODUCTION: Hypothyroidism is a condition in which the thyroid gland is underactive, resulting in a deficiency of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). In rare cases, hormone production may be sufficient, but thyroid hormones may have insufficient peripheral effects. Hypothyroidism may be congenital or acquired.

   ETIOLOGY:

CONGENITAL HYPOTHYROIDISM AQUIRED HYPOTHYROIDISM
Sporadic (∼ 85% of cases) [3]Thyroid hypoplasia, dysplasia, or ectopyThyroid aplasia (athyroidism)Transplacental transmission of maternal antithyroid antibodiesIodine deficiencyHereditary (∼ 15% of cases)Dyshormonogenetic goiter: Defects in thyroid hormone synthesis (most commonly in thyroid peroxidase) lead to thyroid hyperplasia and goiter.Peripheral resistance to thyroid hormones Primary hypothyroidism: insufficient thyroid hormone productionHashimoto thyroiditisThe most common cause of hypothyroidism in iodine-sufficient regions Associated with other autoimmune diseases (e.g., vitiligo, pernicious anemia, type 1 diabetes mellitus, and systemic lupus erythematosus)Postpartum thyroiditis (subacute lymphocytic thyroiditis)  De Quervain thyroiditis (subacute granulomatous thyroiditis): often subsequent to a flu-like illness Iatrogenic: e.g., post thyroidectomy, radioiodine therapy, antithyroid medication (e.g., amiodarone, lithium)Nutritional (insufficient intake of iodine): the most common cause of hypothyroidism worldwide, particularly in iodine-deficient regionsRiedel thyroiditis: occurs in IgG4-related systemic diseaseWolff-Chaikoff effect                          Secondary hypothyroidism: pituitary disorders (e.g., pituitary adenoma) → TSH deficiencyTertiary hypothyroidism: hypothalamic disorders → TRH deficiency

 PATHOPHYSIOLOGY:

Hypothalamic-pituitary-thyroid axis

The hypothalamus, anterior pituitary gland, and thyroid gland, together with their respective hormones, comprise a self-regulatory circuit referred to as the “Hypothalamic-pituitary-thyroid axis.

  • Primary hypothyroidism: peripheral (thyroid) disorders → T3/T4 are not produced (↓ levels) → compensatory ↑ TSH
  • Secondary hypothyroidism: pituitary disorders → ↓ TSH levels → ↓ T3/T4 levels
  • Tertiary hypothyroidism: hypothalamic  disorders → ↓ TRH levels → ↓ TSH levels → ↓ T3/T4 levels

CLINICAL FEATURES: General signs and symptoms

Symptoms related to decreased metabolic rate     Symptoms related to generalized myxedema Symptoms of hyperprolactinemia Future symptoms  
  Fatigue, decreased physical activity               Cold intolerance   Decreased sweating Hair loss, brittle nails , and cold, dry skin Weight gain (despite poor appetite)      Constipation    Bradycardia   Hypothyroid myopathy; , myalgia, stiffness, cramps   Woltman sign: a delayed relaxation of the deep tendon reflexes, which is commonly seen in patients with hypothyroidism, but can also be associated with advanced age, pregnancy, and diabetes tunnel mellitus.   Entrapment syndromes (e.g., carpal syndrome)   Doughy skin texture, puffy appearance   Myxedematous heart disease (dilated cardiomyopathy, bradycardia,dyspnea)   Hoarse voice, difficulty articulating words Pretibial and periorbital edema   Myxedema coma       Abnormal menstrual cycle (esp. secondary amenorrhea; or menorrhagia)   Galactorrhea   Decreased libido, erectile dysfunction , delayed ejaculation, and infertility in men   Impaired cognition (concentration, memory), somnolence, depression     Hypertension   Goiter (in Hashimoto thyroiditis) or atrophic thyroid (in atrophic thyroiditis)

DIAGNOSTICS:

  • TSH Levels         
CONGINITAL AQUIRED
Neonatal screening to measure TSH  levels 24–48 hours after birth is required by law. Increased TSH levels indicate congenital hypothyroidism.   The initial step is to determine TSH levels, which may be followed by measurement of FT4 levels to confirm or rule out the suspected diagnosis.
  • Antibody testing
  • Tg Ab (thyroglobulin) and TPO Ab (thyroid peroxidase): detectable in most patients with autoimmune hypothyroidism
  • TRAb(TSH receptors)
  • Radioactive iodine uptake test
  • Ultrasound of thyroid gland
  • Associated conditions
  • Hypercholesterolemia (increased LDL), hyperlipidemia, hypoglycemia
  • Increased creatine kinase
  • Mild anemia 
  • Possibly hyponatremia

DIFFERENTIAL DIAGNOSIS:

  • Euthyroid sick syndrome
  • Hashimoto thyroiditis
  • Postpartum thyroiditis
  • Subacute granulomatous thyroiditis (De Quervain)
  • Postpartum thyroiditis
  • Congenital hypothyroidism
  • Riedel thyroiditis

COMPLICATIONS:

  • Myxedema coma
  • Primary thyroid lymphoma 
  • Increased cardiovascular risk
  • Carpal tunnel syndrome

 HOMOEOPATHIC MEDICINE FOR HYPOTHYROIDISM:

THYROIDINUM: Dry, congested, raw, burning; worse left side Goitre. Excessive obesity. Thyroid produces anemia, emaciation, muscular weakness, sweating, headache, nervous tremor of face and limbs, tingling sensations, paralysis. Heart rate increased, exophthalmus and dilation of pupils. In myoedema and cretinism its effects are striking. Thyroid exercises a general regulating influence over the mechanism of the organs of nutrition, growth and development. Thyroid weakness causes decided craving for large amount of sweets.,

IODIUM: Larynx feels constricted. Eustachian deafness. Thyroid enlarged. Goitre, with sensation of constriction. Swollen submaxillary glands. Uvula swollen.

 SPONGIA TOSTA: Thyroid gland swollen. Stitches and dryness. Burning and stinging. Sore throat; worse after eating sweet things. Tickling causes cough. Clears throat constantly.

 CALCAREA CARBONICA: Swelling of tonsils and submaxillary glands; stitches on swallowing. Hawking-up of mucus. Difficult swallowing. Goitre. Parotid fistula.

KALIUM IODATUM: It acts prominently on fibrous and connective tissues, producing infiltration, edema, etc. Glandular swellings. Purpura and hemorrhagic diathesis. Syphilis may be indicated in all stages: . Diffused sensitiveness –(glands, scalp, etc).

GRAPHITES: Like all the carbons, this remedy is an anti-psoric of great power, but especially active in patients who are rather stout, of fair complexion, with tendency to skin affections and constipation, fat, chilly, and costive, with delayed menstrual history, take cold easily. -Ophthalmia, with intolerance of artificial light. Eyelids red and swollen. Blepharitis. Dryness of the lids. Eczema of lids; fissured.

DISCUSSION AND CONCLUSION:

Homoeopathy is a system of medicine in which treatment is based on similarity of symptoms. There are many more remedies for hypothyroidism  in homoeopathy. With the selection of similar remedy based on totality of symptoms can successfully manage the cases.

About Author:

Dr. Ashok yadav,

HOD  Dept. of Practice of Medicine (Hom.) Dr. M.P.K. Homoeopathic Medical College, Hospital and Research Center. Homoeopathy University, Jaipur.

     Dr. Navneet Kaur ,,Dr. Mansi Mishra , Dr. Dharmendra Saini , Dr. Sonu Mahiya

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