IJFIRH - 2024, Volume - II, Issue - III [July to September 2024]

e-ISSN No- 3048-6270

Published by Homoeopathic Chronicles

Article Received: 10 August 2024 - Accepted: 24 August 2024 - Article published online: 30 September 2024 

DOI: https://doi.org/10.59939/3048-6270.2024.v2.i3.2 

ABSTRACT

Hypothyroidism is a prevalent endocrine disorder characterized by inadequate production of thyroid hormones, primarily affecting women. This review examines the epidemiology, causes, symptoms, diagnosis, treatment, complications, and management of hypothyroidism, with emphasis on recent research findings. Currently, diabetes mellitus and thyroid illness are India's two most prevalent endocrine disorders, respectively. It more frequently affects women, and the risk rises with age and for people who have a family history of thyroid issues. [1] In India, 11% of people have hypothyroidism, compared to 2% in the UK and 4.6% in the USA. [2]

Homoeopathic medication is essential in the treatment of thyroid disorders. In the case of hypothyroidism, the medications have a strong effect on the hypothalamic-pituitary axis. Medicine is used on sick people to modulate their immune responses to a desirable degree. This is known as immunological modulation. Homoeopathic medication can thereby normalize T3, T4, and TSH results and keep the thyroid gland functioning normally. [3]

KEYWORDS:  Hypothyroidism, Prevelance, Homoeopathy on Hypothyroidism.

INTRODUCTION:

Hypothyroidism arises from reduced thyroid hormone synthesis by the thyroid gland, leading to metabolic disturbances and various systemic effects. Understanding its etiology, clinical presentation, and management strategies is essential for optimizing patient care and outcomes.

Hypothyroidism occurs when the thyroid gland fails to function adequately or when the hypothalamus or pituitary gland fails to stimulate the thyroid gland properly. Hypothyroidism is characterized by decreased thyroid hormone output. Because of reduced hormone release over a longer length of time. It develops a hypometabolic condition. [3]

Over 90% of instances of hypothyroidism, with the exception of regions where iodine deficiency is widespread, are caused by autoimmune illness, thyroid failure, or surgical therapy of thyrotoxicosis. About six times, women experience more than men. [4]

CAUSES AND PATHOPHYSIOLOGY

The most common cause of hypothyroidism worldwide is autoimmune thyroiditis, particularly Hashimoto's thyroiditis, where autoimmune destruction of thyroid tissue impairs hormone production. [5] Other causes include iodine deficiency, which affects thyroid hormone synthesis [6]; thyroid surgery or radiation therapy for thyroid cancer, which may damage thyroid tissue [7]; medications like lithium and amiodarone that interfere with thyroid function [8]; and congenital thyroid abnormalities such as dysgenesis or ectopia [9]. Pathophysiologically, reduced thyroid hormone levels disrupt metabolic processes, leading to systemic manifestations. [4]

SYMPTOMS AND CLINICAL PRESENTATION

In most cases, the onset of hypothyroidism is gradual, and symptoms may appear later in the disease process. Symptoms are often non-specific, with fatigue, cold intolerance, and constipation being the most prevalent. As a result, clinical presentation varies greatly, and the presence of symptoms has a low sensitivity and positive predictive value (symptoms are not specific to hypothyroidism) for diagnosis. As a result, detecting high TSH and low fT4 levels is needed for diagnosis. [10] Hypothyroidism presents with diverse symptoms that can vary widely in severity and onset. Common manifestations include fatigue, weight gain, cold intolerance, dry skin, constipation, and depression [11]. These symptoms reflect the metabolic slowdown and altered energy regulation characteristic of the condition.Some hypothyroidism symptoms are more indicating than others, such as dry skin, proximal myopathy, constipation, cold intolerance, and dry, brittle hair. The manifestation of hypothyroidism varies by a number of factors, including age and gender. [12]

Hypothyroidism is mainly classified into three types:

1. Primary hypothyroidism: due to a defected thyroid gland, unable to generate and secrete thyroid hormone. Iodine insufficiency is the main cause of this condition.

2. Secondary hypothyroidism: Due to a problem with the hypothalamo-pituitary axis, there is insufficient TSH production. This results in decreased thyroidal stimulation, which in turn results in decreased production of T3 and T4. Diseases of the pituitary or hypothalamus are the main causes in this case.

3. Congenital hypothyroidism: From birth, the gland does not fully develop for optimal functioning. [3]

Hypothyroidism (primary hypothyroidism) is most frequently caused by a thyroid gland intrinsic abnormality. TSH is raised in this particular scenario, typically above 20 mU/L, while serum T4 is low. Serum T3 measurements are unhelpful because they cannot consistently distinguish between euthyroidism and hypothyroidism. Failure of TSH secretion in a patient with hypothalamic or anterior pituitary illness results in the uncommon syndrome known as secondary hypothyroidism. This has a low serum T4 level but a low, normal, or even slightly increased TSH.[4]

DIAGNOSIS

Diagnosis of hypothyroidism involves clinical evaluation, thyroid function tests (TSH and T4 levels), and occasionally imaging studies or thyroid ultrasound to assess glandular morphology and detect underlying pathology [13]. Laboratory findings typically show elevated TSH levels with low or normal T4 levels, indicating primary hypothyroidism.

TREATMENT AND MANAGEMENT

The cornerstone of hypothyroidism management is thyroid hormone replacement therapy using synthetic thyroxine (levothyroxine). This therapy aims to restore euthyroidism and alleviate symptoms. [14] Treatment initiation and dosage adjustments are guided by regular monitoring of thyroid function tests, ensuring optimal hormone levels and minimizing risks of cardiovascular disease, osteoporosis, and reproductive disorders. [15]

COMPLICATIONS AND PROGNOSIS

Untreated or poorly managed hypothyroidism can lead to significant complications, including cardiovascular disease, neurocognitive deficits, infertility, and myxedema coma in severe cases. [16] Long-term prognosis improves with early diagnosis, appropriate treatment adherence, and regular follow-up care. Thyroid dysfunction caused by COVID-19 has been documented, with hypothyroidism mostly described as a result of subacute thyroiditis, although the actual mechanism is unknown. [10]

GENERAL MANAGEMENT

LIFESTYLE MODIFICATION

• Diet: Patients should maintain a balanced diet. Certain substances, like calcium and iron supplements, can interfere with levothyroxine absorption, so timing and management of these are important. Dietary advice should be personalized based on individual needs. [17]

• Exercise: Regular physical activity can help manage symptoms such as fatigue and weight gain associated with hypothyroidism. [18]

• Thyroid Disease During Pregnancy: For women with hypothyroidism during pregnancy, updated guidelines from the American Thyroid Association offer specific recommendations for managing thyroid disease to optimize maternal and fetal outcomes. [17]

• Mental Health: Depression and cognitive changes are common in hypothyroidism. Addressing these with appropriate mental health support is vital. [19]

REGULAR MONITORING

• Thyroid Function Tests: Periodic TSH and free T4 tests to monitor thyroid function and adjust medication as needed. Every 6-12 months Follow-up or as directed by the healthcare provider.[20]

• Symptom Tracking: keeping a log of symptoms to discuss with the healthcare provider during check-ups. Can use a symptom diary, which helps in assessing the effectiveness of treatment and making necessary adjustments. [21]

MEDICATION

• Thyroid Hormone Replacement Therapy: The cornerstone of hypothyroidism management is levothyroxine (L-T4), a synthetic thyroid hormone. It is crucial for normalizing thyroid hormone levels and alleviating symptoms. The dosage is personalized based on patient-specific factors such as age, weight, and initial TSH levels.[22]

CROSS REPERTORY

Homoeopathic medicines are utilized to treat various thyroid hormone dysfunctions, and the best results are obtained by repertorizing in multiple repertories. [23]

Types of Cross Repertorization:

1. Symptom-Based Cross Repertorization:

   • Using different repertories to find rubrics for each individual symptom of the patient.

   • Ensuring each symptom is well-represented across the repertories.

2. Remedy-Based Cross Repertorization:

   • Finding the best remedies for the case from one repertory.

   • Cross-referencing these remedies in other repertories to confirm their relevance.

3. Combined Repertorization:

   • Combining rubrics from different repertories into one repertorization chart.

   • Merging the strengths of each repertory to cover a broader spectrum of symptoms. [24]

METHODOLOGY

1. Case Taking and Symptom Analysis:

   • Document detailed symptoms including their peculiarities, modalities, and associated conditions.

   • Identify key symptoms and prioritize them based on their significance.

2. Rubric Selection from Primary Repertory:

   • Choose a primary repertory (e.g., Kent, Synthesis, Murphy’s).

   • Select rubrics that best match the patient's symptoms.

3. Initial Repertorization:

   • Perform repertorization using the primary repertory.

   • Identify the top remedies suggested by the repertory analysis.

4. Cross-Referencing in Secondary Repertories:

   • Use secondary repertories to find the same rubrics or their closest equivalents.

   • Compare the remedies listed under these rubrics.

5. Analysis and Comparison:

   • Analyze the remedies that consistently appear across different repertories.

   • Consider the consistency and significance of the remedies in relation to the patient’s symptoms.

6. Confirmation with Materia Medica:

   • Verify the final selection of remedies using Materia Medica.

   • Ensure the remedies align with the patient's overall symptom picture, including generalities and peculiarities. [25]

RUBRICS

SYSTHESIS REPERTORY

·         GENERALS - HYPOTHYROIDISM: (41) alum. am-br. ange-s. arg-n. ars. bacls-7. bar-c. calc. calc-i. calc-met. Calc-sil.carc. con. cortico. cortiso. flor-p. gels. graph. hist. hypoth. Iod.kali-c. kali-i. levo. Lith-met.lith-p. lith-s. luf-op. lyc. merc. Nat-m.nux-v. penic. psor. puls. rib-ac. sep.sulph. thala. thiop. Thyr.

·         EXTERNAL THROAT - GOITRE: (148) acon. adon. adren. Ail.aloe am-c. am-m. Ambr.AML-NS.anh. antip. Apisaq-mar. aran-ix. ars. ars-i. atra-r. Aur.aur-ar. Aur-i.aur-s. Bad.bar-c. bell. brass-o. Brom.bry. bufoCact.cadm-i. CALC.calc-br. Calc-f.Calc-i.Calc-s.calc-sil. cann-i. Carb-an.Carbn-s.card-m. Caust.chel. chin. chinin-ar. chr-s. cimic. Cist.colch. con. crot-c. crot-h. cupr. cupr-act. cyt-l. dig. diphtox. dros. dubo-m. echi. elapsephe. Ferr.Ferr-i.ferr-p. ferr-s. Fl-ac.flor-p. form. fuc. Glon.Graph.hall ham. hed. Hep.hippoz. Hydr.Ign.IOD.iris jab. kali-bi. kali-c. Kali-i.lac-c. Lach.lap-a. Lyc.LYCPS-EU.Lycps-v.mag-br. mag-c. mag-f. mag-p. mang. marb-w. meph. merc. Merc-i-f.Merc-i-r.Nat-c.NAT-M.Nat-p.Nat-s.nit-ac. nux-v. ol-j. op. petr. Phos.phyt. Pilo.pineal. plat. podo. Psor.puls. Rauw.saroth. scut. sec. sel. Sep.Sil.spartin-s. spig. SPONG.staph. stram. stroph-h. sul-i. sulfa. sulph. syc. tab. Tarent.thal. thala. thym-gl. Thyr.thyreotr. Thyroiod.Tub.urt-u. verat. verat-v. vip. zinc-i.

·         EXTERNAL THROAT - THYROID GLAND; COMPLAINTS OF: (62) adren. am-c. am-m. apisars. aur-s. bad. Bar-i.Bell.Brom.calc. calc-f. calc-i. caust. chr-s. cist. cortiso. Crot-c.des-ac. diph-t-tpt. diphtox. ferr. ferr-s. Fl-ac.flav. Fuc.glon. hep. Hydr.hydr-ac. influ. IOD.Iris jab. kali-c. kali-i. kali-s. Lap-a.Lith-i.lyc. lycps-v. mag-p. Mang-i.merc. Merc-i-f.nat-i. nat-m. phos. phyt. pineal. psor. puls. sil. spect. spong. strept-ent. sulph. thal-met. thyr. Thyroiod.v-a-b. Zinc-i. [26]

RELIABLE REPERTORY

·         Generalities; Hypothyroidism(3) : aq-mar.,  flor-p.,  iod. [27]

COMPLETE REPERTORY

·         Clinical; Hypothyroidism(38) : absin.,  aeth., anac., ange-s., arn., aur., bac., bar-c.,  bufo, calc-p., calc., carc., cortico., cortiso., ferr-i., flor-p., hell., ign., iod., kali-c., lant-p.,  lap-a., levo., lol., nat-c., neod., nux-v., oxyt., ph-ac., plb., rib-ac., sulfa., sulph., thal., thiop., thuj.,  thyr., tub. [27]

   KENT REPERTORY

·         External throat; Goitre(48) : ail., aloe, am-c.,  ambr.,  apis,  aur-i.,  aur.,  bad., bell.,  brom., calc-f.,  calc-i., calc-s., calc.,  carb-an.,  carbn-s.,  caust., 2cist., con., crot-c., 2ferr-i.,  fl-ac., form.,  hep.,  iod., kali-c.,  kali-i.,  lach., lap-a.,  lyc.,  lycps., mag-c., 2 merc-i-f., merc-i-r.,  nat-c., nat-m.,nat-p.,  nat-s.,  phos., plat., podo. ,sil.,  spong., stram., tab., tarent.,  tub., urt-u. [26]

BOGER SYNOPTIC KEY REPERTORY

·         Neck; External throat; glands of(19) : am-m.,  bar-c., bell., brom., calc-f., calc-i., calc-p., calc., cham., graph., ign., iod., lach., lyc., nat-m., rhus-t., spong., staph., sulph.

·         Neck; External throat; glands of; thyroid, goitre(4) : hep., ign., vip., zinc-i. [27]

   BBCR REPERTORY

·         External throat; Glands, cervical and submaxillary; goitre(23) : am-c.,ambr., brom., calc., carb-an., caust., con., dig., hep.,  iod., kali-c., lyc., mag-c., merc., nat-c.,  nat-m., petr., phos., plat., sil., spong.,staph., sulph[26].

 BTPB REPERTORY

·         Parts of the body and organs - External throat - goitre: (21) am-c. AMBR.bell. Calc.Carb-an.caust. con. dig. IOD.kali-c. lyc. mag-c. Merc.NAT-C.Nat-m.petr. phos. Plat.sil. SPONG.sulph. [26]

PHATAK REPERTORY

·         Thyroid; dysfunction(1) : calc.

·         Phatak - Phatak repertory; Thyroid; pinched, as if,(1) : nat-ar.[26]

Repertorial Result:

Based on the above given rubrics of hypothyroismfrom different repertories.

1.      Iod.

2.      Calc.

3.      Nat-c.

4.      Hep.

5.      Kali-c.

6.      Spong.

7.      Lyc.

8.      Am-c.

9.      Ambr.

10.  Caust

Iodum

·         Indications: Useful in cases of significant weight loss despite a good appetite, nervousness, and restlessness. Often indicated for patients with a fast metabolism and goiter.

·         Mental Symptoms: Anxiety, restlessness, and a tendency to be overly excitable.[28,29]

CalcareaCarbonica (Calc.)

·         Indications: Ideal for patients with fatigue, weight gain, cold intolerance, and sluggish metabolism. Often suited for individuals who sweat easily, especially on the head, and have a craving for eggs.

·         Mental Symptoms: Anxiety, fear of failure, and a sense of being overwhelmed.[28,29]

NatrumCarbonicum (Nat-c.)

·         Indications: Addresses digestive disturbances, sensitivity to weather changes, and chronic fatigue. Suitable for individuals with dry skin and cold extremities.

·         Mental Symptoms: Depression, irritability, and sensitivity to criticism.[28,29]

HeparSulphurisCalcareum (Hep.)

·         Indications: Effective for cases with a tendency to infections, sensitivity to cold, and irritability. Often used for patients with slow metabolism and skin issues.

·         Mental Symptoms: Irritability, hypersensitivity, and a tendency to be easily offended.[28,29]

Kali Carbonicum (Kali-c.)

·         Indications: Suitable for patients with back pain, swelling, and coldness. Often indicated for those with digestive issues like bloating and constipation.

·         Mental Symptoms: Rigidity, anxiety, and a desire for company.[28,29]

SpongiaTosta (Spong.)

·         Indications: Used for thyroid enlargement (goiter) and respiratory issues. Suitable for patients with a dry cough and a sense of suffocation.

·         Mental Symptoms: Anxiety about health and fear of heart disease.[28,29]

LycopodiumClavatum (Lyc.)

·         Indications: Useful for digestive disturbances, such as bloating and constipation, along with fatigue and cold intolerance. Suited for individuals with hair loss and dry skin.

·         Mental Symptoms: Lack of self-confidence, fear of public speaking, and a tendency to be domineering.[28,29]

Ammonium Carbonicum (Am-c.)

·         Indications: Suitable for patients with respiratory issues, cold intolerance, and general weakness. Often indicated for those with dry skin and swollen glands.

·         Mental Symptoms: Depression, irritability, and difficulty concentrating.[28,29]

AmbraGrisea (Ambr.)

·         Indications: Effective for patients with nervousness, digestive issues, and cold extremities. Often suited for older adults with chronic fatigue and weakness.

·         Mental Symptoms: Shyness, social anxiety, and difficulty in social interactions. [28,29]

Causticum (Caust.)

·         Indications: Used for patients with muscle weakness, joint pain, and chronic fatigue. Suitable for those with dry skin and hoarseness.

·         Mental Symptoms: Anxiety about the future, a strong sense of justice, and a tendency to feel deeply affected by others' suffering.[28,29]

CONCLUSION

Hypothyroidism is a prevalent endocrine disorder with diverse clinical manifestations and significant implications for health and quality of life. Advances in understanding its pathophysiology and treatment options underscore the importance of early detection and comprehensive management.

The management of hypothyroidism through homeopathy involves a detailed, individualized approach that considers the patient's unique set of symptoms, both physical and emotional. By using the method of cross-repertorization, homeopaths can systematically select remedies that best match the totality of the patient's symptoms. This ensures a more tailored and effective treatment plan.

Homeopathy offers a holistic approach to managing hypothyroidism, aiming to restore balance and stimulate the body's natural healing processes. Regular follow-ups and adjustments to the treatment plan are essential to monitor progress and ensure optimal outcomes. This personalized and comprehensive method highlights the importance of viewing each patient as a whole rather than merely treating isolated symptoms.

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