e-ISSN No- 3048-6270
Published by Homoeopathic Chronicles
EFFECTIVENESS OF INDIVIDUALISED HOMOEOPATHIC REMEDY IN THE TREATMENT OF SUBCLINICAL HYPOTHYROIDISM - A CASE REPORT
Ananya Balakrishna1, Praveen Kumar2
1MD Scholar, Department of Case Taking & Repertory, Government Homoeopathic Medical College and Hospital, Bengaluru- 560079; Email: ananya.891@gmail.com
2Assistant Professor Department of Case Taking & Repertory, Government Homoeopathic Medical College and Hospital, Bengaluru- 560079; Email: drpraveenmj@gmail.com
Article Received: 10 December 2024 - Accepted: 20 December 2024 - Article published online: 30 December 2024
DOI: https://doi.org/10.59939/3048-6270.2024.v2.i4.4
ABSTRACT
Subclinical Hypothyroidism (SCH) is a prevalent endocrine disorder marked by an underactive thyroid gland, which can lead to symptoms such as irregular menses, hairfall, fatigue, weight gain, cold intolerance, and mood disturbances. Biochemically, the condition is characterized by elevated serum Thyroid Stimulating Hormone (TSH) levels, with serum triiodothyronine (T3) and thyroxine (T4) concentrations falling within the lower or normal limits of the reference range. A 29-year-old female, consulted in OPD of GHMC&H Bengaluru on 4.7.24 with irregular menses and diffuse hairfall since 6 months associated with history of weight gain, lethargy, dryness of skin, lack of concentration, small quantity of food causes fullness and constipation. As per the investigations on 2.7.24, elevated TSH value was found to be 7.360µIU/mL. After thorough case taking, homoeopathic treatment with Calcarea Phosphoricum 200 & 1M led to remarkable improvement assessed using modified Naranjo criteria. With 6 months of individualised Homoeopathic treatment, TSH level is found to be within the normal limits i.e 1.71µIU/mL as per the investigations on 13.12.24.The homoeopathic system of medicine, through its individualized and holistic approach, has been reported to improve serum thyroid profiles in SCH patients. Additionally, it addresses overall vitality and immunity, leading to enhanced well-being in a shorter time frame.
KEYWORDS: Subclinical Hypothyroidism, Case Report, Homoeopathy, Calcarea phosphoricum
INTRODUCTION
Subclinical hypothyroidism is biochemically defined as an elevated serum thyrotropin level in combination with a serum free T4 level that is within the population reference range. The incidence of SCH varies among populations and ranges from 3 to 15%, with a higher incidence associated with increasing age, female sex1. Iodine shortage is the most frequent cause of hypothyroidism in the world. Subclinical hypothyroidism is asymptomatic most of the time. However, it can present with symptoms of hypothyroidism like dry skin, hair loss, constipation, dysphagia, loss of appetite, dyslipidemia, decreased attention span, muscular weakness, cramps, stiffness, fatigue, irregular periods, menorrhagia, decreased libido, weight gain, cold intolerance, etc2.
Current guidelines tend to recommend thyroid hormones for adults with thyroid stimulating hormone (TSH) levels >10 mIU/L and for people with lower TSH values who are young, symptomatic, or have specific indications for prescribing3. TSH >10 mIU/L persons had a rate of 3% to 8%. While thyroid hormone replacement therapy is the standard treatment for subclinical hypothyroidism (SCH), recent studies indicate that there are no clinically meaningful benefits of levothyroxine replacement for quality of life or thyroid-related symptoms in nonpregnant adults with SCH (thyrotropin level elevated but ≤10 mIU/L and normal free thyroxine [FT4] levels)4.
Calcarea phosphoricum is a tubercular remedy and belongs to the mineral kingdom. It has a special affinity to anemic people, peevish flabby have cold extremities and feeble digestion with tendency to perspiration & glandular enlargement5,6. It has a significant action and influences the thyroid hormone target tissue which is goitrogenic7. SCH falls under the ICD -11 code 5A00.Z. Constitutional prescription is a method to identify the constitution of an individual and treat the patient as a whole irrespective of names of the diseases and organs affected. The choice of remedy is entirely based on the individual’s totality of all mental and physical reactions. It is based on the Principle of Homoeopathy “SIMILIA SIMILIBUS CURANTER”. The following case report is an example how holistic approach can contribute to the prompt and complete improvement of the patient.
CASE REPORT
A 29-year-old female patient, Mrs A reported to the outpatient department of Government Homoeopathic Medical College and Hospital on 4.07.2024 with the complaints of irregular menses and hair fall since 6 months.
HISTORY OF CHIEF COMPLAINT
Patient was apparently well 7 months ago. She started with the c/o irregular menses and diffuse hairfall since 6 months, her cycles were once in 2 months or 3 months. LMP was 12.04.24. Flow lasted for 3-4days with minimal clots. She consulted a gynaecologist and started taking hormonal pills. She used to get menses only if she takes the hormonal pills otherwise, menses gets delayed. Her complaints were associated with history of weight gain, lethargy, dryness of skin, lack of concentration, small quantity of food causes fullness and constipation.
PAST HISTORY
Medical history: H/o dengue at 19 years of age; took allopathic treatment
Treatment history: Took hormonal pills for her c/o irregular menses
Surgical history: Nothing significant
Allergic history: Not allergic to drug, diet and dust.
MENSTRUAL HISTORY:
PAST MENSTRUAL HISTORY:
Age of Menarche – At 11 years of age
Cycles – Regular
Duration of menstrual period – 3 days
Flow – Moderate (D1- 2 pads; D2- 2pads; D3- spotting)
Colour of the flow – Red
Smell – Not present
Clots – Present (minimal)
Associated complaints –Pain in lower abdomen on 1st or 2nd day of menses
Leucorrhea 1 week before menses
PRESENT MENSTRUAL HISTORY:
LMP – 12.04.2024
Cycles – Irregular
Duration of menstrual period – 4 days
Flow – Moderate (D1- 2 pads; D2- 2pads; D3 4- spotting)
Colour of the flow – Dark red
Smell – Not present
Clots – Present (minimal)
Associated complaints - lower abdominal pain on 1st & 2nd day of menses
Leucorrhea 3 days before menses
PERSONAL HISTORY
• DIET : Mixed
• HUNGER : Tolerable
• APPETITE : Reduced, easy satiety
• THIRST : Thirsty ,drinks 3-4 litres/day
• CRAVING : Smoked food
• AVERSION : Nothing specific
• BOWEL HABITS : Irregular, alternate days, hard, unsatisfactory
• BLADDER HABITS : 4-5 times per day; 1-2 time per night
• SLEEP : Sound, refreshed
• DREAMS : Unremembered
• PERSPIRATION : Generalised
• THERMAL STATE : Chilly patient
• ADDICTION : Tea : 2-3 times/day
LIFE SPACE INVESTIGATION
Patient hails from middle socioeconomic family background. Her father is an engineer and mother is a housewife. She was born and bought up in Bangalore. She has one younger sister.
CHILDHOOD: Her childhood was uneventful. Shares good relationship with parents and her sibling.
ADULTHOOD: She joined coaching classes for Chatered accountacny examination preparation during her Bcom. There were times she studied for 16hours a day. But she failed to clear the CA exams even after trying for 2 years. Later she joined a reputed firm to work.
MARRIAGE: Married at the age of 24years.She has a good relationship with her husband.
WORK: She started working in an asset management company few months after marriage. She had no issues at work place.
CHILD: She has one daughter who is healthy and 2years of age. She resigned her job after the delivery of her child, as she was unable to manage both child and job together.
WITH FAMILY: She had to do all the household chores, she felt frustrated for being at home and not going for the job as she had no help. She gets easily annoyed of any domestic issues with her in laws and shouts at them in anger. 7-8 months back her mother-in-law shouted at her for something which she was not at fault, in front of other family members. After this her menses became irregular, she started gaining weight and has diffuse hairfall.
AS A PERSON: She lacks confidence. Cannot take decisions on her own, Anxious about her health since her complaints.
ON OBSERVATION: Slow, Sensitive.
GENERAL PHYSICAL EXAMINATION
Weight: 75 kg
Height: 160 cm BMI: 29.29 kg/mt²
Moderately built and nourished
Pulse: 78 / min, regular rhythm, normal volume
Blood pressure: 120/70 mmHg;
Respiratory rate: 16 breaths/min;
Temperature: Afebrile at the time of examination
Neck : Acanthosis nigricans present
Skin & nails: dryness of skin
No signs of pallor, cyanosis, clubbing, icterus, lymphadenopathy, edema.
LOCAL EXAMINATION
EXAMINATION OF THYROID GLAND
INSPECTION: Acanthosis nigricans present & no other skin changes
No scars
No mass/swelling seen
No movement of gland elicited-swallowing & on protrusion of tongue
PALPATION: No tenderness
No mass felt palpation
Symmetrical thyroid lobes elevation on swallowing
No lymphadenopathy
No tracheal deviation
PERCUSSION: No dullness elicited in retrosternal space
AUSCULTATION: No bruits heard over both lobes
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM
No abnormality detected
CARDIO VASCULAR SYSTEM
No abnormality detected
GASTROINTESTINAL SYSTEM
No abnormality detected
NERVOUS SYSTEM EXAMINATION
No abnormality detected
PROVISIONAL DIAGNOSIS
HYPOTHYROIDISM
INVESTIGATION DONE
DATE: 02.07.2024
THYROID PROFILE (Figure 1): T3=1.44ng/ml;T4=7.64µg/dl; TSH=7.360µIU/mL
URINE PREGNANCY TEST - Negative
TOTALITY OF SYMPTOM
Lack of confidence
Cannot take own decisions
Sensitive to criticism
Easy satiety
Craving for Smoked meat
Hard unsatisfactory stools
Irregular menses
Hairfall
SELECTION OF REPERTORY: HOMPATH SOFTWARE8
REPERTORIAL TOTALITY AND RESULTS
DISCUSSION
In the above case, patient presented with the complaints of irregular menses associated with hairfall, weight gain, lethargy, constipation and dryness of skin. Her thyroid profile showed normal T3, T4 levels with elevated TSH levels of 7.360 µIU/mL(Figure 01). CALCAREA PHOSPHORICUM 200 and 1M was prescribed after repertorising based on the totality of the patient considering her mind and physical generals, with the help of HOMPATH Software5(Figure 02). After first prescription patient got her menses. Totally five follow ups were done and the patient started improving since the first prescription. Patient’s menses became regular, hairfall reduced,weight was reduced, generals were improved and overall patient felt better. The Thyroid profile was repeated on 13/12/24 which showed normal TSH levels of 1.71 µIU/mL(Figure 03).
This shows how Homoeopathic remedies acts rapidly, gently and are safer for cases of Subclinical Hypothyroidism with overall improvement of the patient, unlike the conventional mode of treatment with thyroid hormone replacement therapy that would have significant side effects.
Also, in the following case the changes in the casual attribution were assessed using Modified Naranjo Criteria6 (Table 06). Total score as per the criteria in this case is (+9) which is relatively close to the total of +13 which signifies the positive casual attribution of individualized homoeopathic remedy to the clinical outcome.
CONCLUSION
This case is evidence for homoeopathy having prolific results in cases of Subclinical Hypothyroidism with complete recovery of a person without thyroid replacement therapy, since the basis of prescription here has been upholding the importance of holistic and individualistic approach; further verification of the fact has been suggested to evaluate the effectiveness of homoeopathic treatment in Subclinical Hypothyroid.
CONFLICT OF INTEREST: None
FINANCIAL SUPPORT: None
DECLARATION OF PATIENT CONSENT
Consent was obtained in the appropriate written consent form. In the form the patient has given her consent for mentioning her clinical information to be reported in the journal. The patient understands that her name and initials will not be published.
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How to cite this Article: Balakrishna A, Kumar P. Effectiveness of individualised homoeopathic remedy in the treatment of subclinical hypothyroidism- a case report. International Journal for Fundamental and Interdisciplinary Research in Homoeopathy [Internet]. 2024 Dec 30;2(4):33–46. Available from: https://doi.org/10.59939/3048-6270.2024.v2.i4.4