Thyroid, Its Disorders & The Homoeopathic Treatment
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Thyroid, Its Disorders & The Homoeopathic Treatment

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Thyroid is the most well known endocrine gland, which has been identified since antiquity, especially by the more commonly known name, Goiter. Thus it has adorned some of paintings, art works and even ...

Thyroid is the most well known endocrine gland, which has been identified since antiquity, especially by the more commonly known name, Goiter. Thus it has adorned some of paintings, art works and even writings.
Thyroid disorders are the most prevalent endocrine disorders known to mankind.
Understanding the entire history, evolutionary biology, embryological development, its role in psychiatry is crucial for its successful treatment.
With the development of Psychoneuroendocrinology we understand how a variety of psychobiological factors interact and result in illnesses and how a state of physiological wellness is so intimately connected with our emotional proclivities.
It refutes the mind/body dichotomy as it is never a mind OR body rather always a mind-body event, which is a fundamental teaching of Homoeopathy.
Some clinical tips on thyroid along with two case studies (one of hyperthyroidism and another of hypothyroidism) are added along with their reports.

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Thyroid, Its Disorders & The Homoeopathic Treatment Presentation Transcript

  • 1. THYROID, ITS DISORDERS & THE HOMOEOPATHIC TREATMENT Gyandas G. Wadhwani, MD (Hom) Chief Medical Officer (Homoeopathy), Directorate of ISM& Homoeopathy,; Senior Lecturer (Organon of Medicine & Homoeopathic Philosophy), Dr B. R. Sur Homoeopathic Medical College, Hospital& Research Centre, Govt of NCT of Delhi. Email: homoeopathygyan@gmail.com
  • 2. Based on the paper titled ‘THE WANING AEGIS OF ‘THE SHIELD’ & ITS RESTORATION WITH HOMOEOPATHY’ presented in National Homoeopathic Conference, Kent Memorial Lectures 2012
  • 3. I saw a woman wearing a sweatshirt with 'Guess' on it. I said, 'Thyroid problem? Arnold Schwarznegger
  • 4. Who is amazed at a swollen neck in the Alps? Juvenal Roman Satirist, 127 AD
  • 5. Thyroid disease • Most prevalent endocrine disorder known to mankind • Annual health care cost of this disease exceeds 50 billion US$ worldwide • By the age 50, 10% of women have abnormal TSH • By the age 60, 17% women and 9% men affected
  • 6. Thyroid- Etymology and History • The word Thyroid is derived from Ancient Greek word ‘thyreoiedes’ (meaning ‘oblong door shaped shield’), which was made up of two words ‘thyreos’ (meaning ‘shield’- ‘Thureos’ was a kind of shield used by heavily armed Greek soldiers; another Greek word ‘thyra’ means ‘door’) and ‘eides’ (meaning ‘form or shape’). • Its long history is inseparable from that of goitre (in Latin ‘guttur’ means ‘throat’), which is known to have been recognised since 2700 BC.
  • 7. Thyroid- Etymology and History • Goiter was also known by a synonym Bronchocele • Ancient latin word Struma probably originally described inflammed Lymph Nodes in the neck but later denotes (and still does) the Thyroid Gland. • A major confusion surrounded scrofula and goiter. • Confounding thyroid gland and goiter continued till almost the beginning of 20th century.
  • 8. Thyroid- Etymology and History • It was mentioned in Hindu holy texts in 300 BC. • Claudius Galenus first used the term ‘thyreoiedes’ for shield-shaped cartilage in order to describe the “Adam’s apple” in the throat. • In 1656, Thomas Wharton used the term “thyroid gland” because of shield- shaped cartilage upon which the gland rests in his Adenographia. • It was Albrecht von Haller, who in 1776 classified Thyroid as a ductless gland.
  • 9. Thyroid, Art & Literature
  • 10. Thyroid, Art & Literature Faith, sir, you need not fear. When we were boys, Who would believe that there were mountaineers Dew-lapp’d like bulls, whose throats had hanging at ’ Wallets of flesh? William Shakespeare ‘The Tempest’, Gonzalo, Act 3, Scene III
  • 11. Thyroid, Art & Literature Scaramuccia: Leonardo Da Vinci
  • 12. Thyroid: Evolutionary Biology • Morphological studies have shown that the thyroid apparatus from the earliest period of its evolutionary history has been an essential part of the digestive tract (Marine) and so intimately related with the genital organs as at one time to have formed an integral part of them (Gaskell).
  • 13. Thyroid: Evolutionary Biology ..In the lowest vertebrates and in the homologous tissues of the higher invertebrates the fractions of the thyroid are intimately connected with the ducts of the sexual organs. They are indeed accessory sexual organs, uterine glands, satellites of the sex process. From Petromyzon (lamprey) upward their relationship is lost. The thyroid migrates more and more to the head region to become the great link between sex and brain…. Dr. Louis Berman The Glands Regulating Personality: A Study of the Glands of Internal Secretion in Relation to the Types of Human Nature
  • 14. Thyroid: Embryological development • Thyroid is almost the first organ to become distinct in the human embryo:by 3-4 weeks of gestation, appearing as an epithelial proliferation in the floor of the pharynx. • The growing foetus starts making its own thyroid stimulating hormone (TSH) by eighth week and • Follicles of the thyroid begin to make colloid in the by 10th week of gestation and thus contribute in development of physical and neurological features.
  • 15. Thyroid: Embryological development • It is interesting to note that thyroid gland arises in the embryo from the same tissue and almost the same spot as does the anterior lobe of the pituitary body- the thyroid is an outgrowth from the endoderm in ventral midline and anterior pituitary is an outgrowth of the ectoderm in dorsal midline.
  • 16. Thyroid: Basic functioning • Thyroid is an energy gland, and its secretion is the controller of the speed of living. • Without thyroid secretion the output of large and rapid fluctuations of energy, and the elasticity and flexibility of energy mobilization for any sudden muscular act, let alone an emergency, would be quite impossible.
  • 17. Thyroid: Basic functioning • It is heavier in the female than in the male, and becomes enlarged during sexual excitement, menstruation, and pregnancy.
  • 18. Thyroid and Pituitary • The anterior lobe of the pituitary body has been called the gland of intellectuality, meaning the capacity of the mind to control its environment by means of concepts and abstract ideas.
  • 19. Thyroid and Pituitary • The secretion of thyroid on the other hand is as necessary for the proper mental activity and reproduction of species. Without this, there can be no complexity of thought, no learning, no education, no habit formation, no responsive energy to meet situations, as well as no development of faculty and physical function; also no reproduction of any kind, with no sign of adolescence at the proper age, and no exhibition of sex tendencies thereafter.
  • 20. Thyroid and Pituitary • The thyroid facilitates energy production, the pituitary its consumption. • The pituitary stimulates the brain cells more directly. • Thyroid controls the mental development and is the great link between the brain and the organs of generation.
  • 21. …Only 3½ grains of Thyroid secretion stands between intelligence and idiocy….
  • 22. Thyroid & Psychiatry • ….Highlighting about “Thyroid Function in Psychiatric Disorders,” David O’Connor, Harry Gwirtsman, and Peter T. Loosen tell us that the prevalence of one or more thyroid abnormalities in acutely hospitalized psychiatric patients ranges from 6% to 49%. ….
  • 23. Thyroid & Psychiatry • … The most common thyroid abnormality among these patients is the euthyroid sick syndrome, which has been observed in both depression and schizophrenia. Of note, this disorder often normalizes upon symptom resolution. Thus, they stress the importance of interpreting thyroid function tests with caution in newly hospitalized or acutely ill patients…
  • 24. Thyroid & Psychiatry • Disturbances of thyroid function are common in eating disorders and occur at twice the rate of the healthy population. • In anorexia nervosa, for example, patients may often have signs and symptoms consistent with hypothyroidism including bradycardia, slowed deep tendon reflexes, and constipation.
  • 25. Thyroid & Psychiatry • In some cases, savvy patients with anorexia nervosa may abuse prescription or over-the-counter thyroid supplements with the aim of inducing a hypermetabolic state and subsequent weight loss. • A potentially confounding situation may arise when a patient with anorexia nervosa also has hyperthyroidism (i.e., Graves’ disease) wherein the hypermetabolic state of Graves’ disease may mask the hypometabolic state often seen in anorexia nervosa!
  • 26. Thyroid & Criminology • It has been hinted by a study that the prisoners in San Quentin convicted of murder have abnormal thyroid glands (blog.modernmechanix.com/crooks-cured-by- surgeons-knife/). Dr. Ralph Arthur Reynolds, San Francisco physician, in cooperation with Dr. Leo Stanley, resident prison physician, stated following a two months' first hand study of the prison's inmates three facts:
  • 27. Thyroid & Criminology …..That every murderer, potential and actual, exhibits over-secretion of the thyroid gland; that a murderer exhibits under-secretion of the pituitary gland, and that every social misfit displays mal-secretion of some gland. The thyroid group was divided into three classes: “First, those having a ‘hyper plasia,’ or overgrowth. “The second class consisted of those having tumorous or lumpy growths .. within the thyroid gland, known as ‘adenoma.’ ” In the third group were gathered those with ‘colloid goiter’….
  • 28. Thyroid & Criminology …. On referring to the records of the crimes committed by these men, approximately seventy percent of the cases those in classifications one and two had committed Crimes of violence; that is, murder, assault with intent to kill, manslaughter, or manslaughter from reckless driving, impulsive action….
  • 29. Thyroid & Criminology …The doctor told of one youthful slayer who for no apparent reason attacked other prisoners with anything he could lay his hands on and as a consequence had spent one hundred and eighty days in the dungeon. The youth had an abnormal thyroid gland, said Dr. Reynolds, upon which "we operated and reduced to what we thought normality. Today that prisoner is entirely tractable." The results, he said, were surprising in sixty other cases personally treated….
  • 30. …It has been shown that a greater number of convicts are mentally and morally sub-normal (deficiency of thyroid secretion). Crimes of passion can be traced in no small part to disturbances of the thyroid. A psychological examiner of a Pittsburgh (Pennsylvania) court, interested in this subject, has found enlarged thyroid in over ninety per cent of delinquent girls… L. Grimberg ‘Emotion and Delinquency: A Clinical Study of Five Hundred Criminals in the Making.’
  • 31. Thyroid disorders
  • 32. Thyroid disorders • Thyroid disorder is a general term representing several different diseases involving thyroid hormones and the thyroid gland. • Thyroid disorders are commonly separated into two major categories, hyperthyroidism and hypothyroidism, depending on whether serum thyroid hormone levels (T4 and T3) are increased or decreased, respectively.
  • 33. Thyroid disorders • Patients often present with a myriad of clinical manifestations; • In particular, the elderly may not associate the signs and symptoms with a disease process and thus may not bring them to the attention of their primary care provider.
  • 34. Thyroid disorders • Dysfunctions in the thyroid can have a major effect on a person's wellbeing even with a mild or subclinical disorder. • Both subclinical hypothyroidism and subclinical hyperthyroidism may not really be "subclinical" in the sense that the effects on the person's health may be profound.
  • 35. Thyroid disorders • The most common complications that can arise from untreated thyroid disease include – Dyslipidemia and subsequent heart disease, – Infertility, – muscle weakness, and – Osteoporosis etc.
  • 36. Restoration of the lost aegis…. Therapeutics
  • 37. Biomedical approach • The Biomedical model of health governed the thinking of most medical practitioners for the past 300 years. • It maintained that all illnesses can be explained on the basis of aberrant somatic bodily processes such as biochemical imbalances and/ or neurophysiological abnormalities.
  • 38. Biomedical approach • Over a period of time several shortcomings of this model were noted the most important being the difficulty in accounting for why a particular set of somatic conditions need not invariably lead to illness. • Also the treatment outcomes which are substantially modified by the psychological and social factors could not be explained by this model.
  • 39. Psychoneuroendocrinology (PNE) • The field of psychoneuroendocrinology came about as research in the first half of the 20th century showed a clear linkage between hormones and brain function. • In the early 1900s, Walter Bradford Cannon postulated that strong emotions influenced physiology through the “sympathico-adrenal medullary system” and described the fight or flight response. Cannon hypothesized that physical and psychological stressors could disturb homeostasis, a term he coined.
  • 40. PNE • In the late 1940s, Geoffrey W. Harris provided evidence that factors released into portal blood from the hypothalamus exerted control over pituitary secretion. • Later, Hans Selye examined the effects of various stressors on the anterior pituitary and adrenal cortex.
  • 41. PNE • PNE deals with the interrelated disciplines of psychology, neurobiology, endocrinology, immunology, neurology, and psychiatry, with an emphasis on multidisciplinary studies aiming at integrating these disciplines in terms of either basic research or clinical implications.
  • 42. PNE • One of the main goals is to understand how a variety of psychobiological factors interact in the expression of the stress response as it relates to the development and/or maintenance of neuropsychiatric illnesses and how a holistic understanding of the person is the need of the hour.
  • 43. Biopsychosocial model of health • Medical researchers have consequently recommended the Biopsychosocial model. This model maintains that the health and illness are caused by multiple factors and produce multiple effects. Also it recognises that mind and body can’t be distinguished in matters of health and illness because both clearly influence an individual’s state of being.
  • 44. Biopsychosocial model of health • The process of diagnosis hence, should always consider the interacting role of biological, psychological and social factors in assessing the health or illness. The recommendations for treatment should also consequently involve all the three set of factors and the therapy should be targeted to the unique individual considering him as a ‘whole unit’ and help in dealing with multiple problems simultaneously.
  • 45. Homoeopathy vis a vis PNE and Biopsychosocial model of health
  • 46. Homoeopathic restoration… • PNE & new model of health establish the real psycho-neuro-endocrino-somatic connection, and establishes how a state of physiological wellness is so intimately connected with our emotional proclivities. • It refutes the mind/body dichotomy as it is never a mind OR body rather always a mind/body event, which is a fundamental teaching of Homoeopathy as given in ‘Organon of the Art of Healing’.
  • 47. Organon of Healing Art § 210 ‘….. since in all other so-called corporeal diseases the condition of the disposition and mind is always altered; and in all cases of disease we are called on to cure the state of the patient's disposition is to be particularly noted, along with the totality of the symptoms, if we would trace an accurate picture of the disease, in order to be able therefrom to treat it homeopathically with success…’
  • 48. Organon of Healing Art § 5 • “Useful to the physician in assisting him to cure are ….. the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient …, his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration.”
  • 49. Since homeopathy embraces this wide semiological approach as inherent practice, using the patho-biographical totality of characteristic symptoms to evaluate organic imbalance in each individual and prescribes suitable tailor-made treatment, homeopathic takes a precedence of the conventional medical approach by two centuries!
  • 50. HOMOEOPATHIC GEMS FOR PRESCRIBING
  • 51. …At the risk of repeating a truism must begin our brief consideration of the homœopathic equivalents of endocrinological remedies with the statement that the most active force for the restoration of normal balance between the endocrine glands is the homœopathic similimum, whatever that may be, whether or no it has ever before been connected with gland function… Elizabeth Wright Hubbard
  • 52. THERAPEUTIC HINTS • Exopthalmic Goiter, History Of Tuberculosis: DROSERA • Pathological concomitants – Intestinal cancer accompanied by toxic goiter: CADMIUM MET – Asthma with Goiter: SPONGIA
  • 53. Homoeopathic Gems from Calvin B. Knerr’s Repertory Of Hering’s Guiding Symptoms of Our Materia Medica Chapter 31: NECK AND BACK; GOITER, NECK:
  • 54. SPONGIA TOSTA • ││ causes asthma • │moving sensation on swallowing • │pain on swallowing • │vascular • │in inhabitants of valleys • ││marked hardness • ││ Constantly increasing, becoming fuller, with slight pain and tenderness on handling, every time she has a cold
  • 55. • ││ large, irregular, • │knotty • ││ lumpy • ││ soft, located esp. in left of thyroid body • ││tender • ││sensation like distension • π stinging on swallowing • stitches
  • 56. IODUM • │sensation of constriction • │hard • │marked hardness • │ hypertrophy of two lobes, tumour becoming more swollen and painful at each return of menses • │ Gradual increase in size,esp right side, soft and without any fluctuation
  • 57. • │non- lobulated tumour in anterior and median portion as large as a child’s head ,rosy –red, heavy in weight and soft • │nodulated • │painless, well marked • │soft and recent • │with vertigo • In scrofulosis
  • 58. CALCAREA CARB • │with otorrhoea • │soft reddish, indolent, moveable, transverse with bluish veins • │of thirty six years’ standing, commencing at thirteen years
  • 59. CALCAREA FLUOR • │ small ones (improved) BROMIUM • │size of a hen’s egg MERCURIUS • becomes softened
  • 60. LYCOPODIUM • │on right side • │on right side,tense, smooth, shining appearance, with feeling of constriction in tumour , as if held in some unyielding envelope, while not very large
  • 61. FERRUM MET • ││exopthalmic, esp after suppression of menses • │exopthalmic CACTUS • │ exopthalmic
  • 62. KALI IOD • │sensitive to contact CISTUS CAN • │with diarrhoea
  • 63. NATRUM CARB • │pressing pain NATRUM PHOSPHORICUM • │ in thirteen cases, the pressure was relieved in three to five days, in some cases a cure was affected
  • 64. SULPHUR • ││large, interfered with respiration , caused oppression when ascending heights or walking quickly RHUS TOXICODENDRON • ││due to tonic spasm of cervical muscles after falling downstairs
  • 65. MY CLINICAL EXPERIENCES: I SHARE A CASE OF HYPERTHYROIDISM (GRAVES DISEASE) AND A CASE OF HYPOTHYROIDISM CURED BY HOMOEOPATHY…. THEY DO NOT NEED LIFELONG MEDICATION!
  • 66. Case NO 1: GRAVES DISEASE Mrs. S., 30 years old female, consulted us on 15th Sept ,2011. On observation she had brown asymmetrical and protruding eyes (right being larger), dark hair, average height and thin built and an angle below glabella. Involuntary sighing frequently.
  • 67. Presenting complaint • On noticing asymmetrical eyes the same year, she got her thyroid profiling done on 28th july, 2011 which showed that she was suffering with thyroid hyperfunction (graves disease).
  • 68. • Post marriage , she also developed tendency for headache which when severe was associated with nausea. • It was located esp. on top of head , was < ODOURS, STRESS- e.g. if someone passed a comment or when work was not completed on time, > by deep sleep. –She used to take tab naxdom and combiflam for it.
  • 69. • She also developed pain in lumbar region (bilateral) just 5-6 days after marriage. • All investigations for the pain (X-ray and MRI) were WNL. • The pain still persists and is < standing for long time ; exertion; lack of sleep
  • 70. • She had suffered with frequent episodes of being unable to breathe easily. The checkups frequently revealed low B.P. The local physician had recommended ‘deriphyllin’ for that.
  • 71. • She also had photosensitive skin in consequence of which she developed itching eruptions in sun exposed areas. • Also, felt heaviness in abdomen with uncomfortable feeling post siesta.
  • 72. Past illnesses • Mumps in early school time • Pain abdomen during school life • Left ear surgery in class xth for congenital perforation • Had had pulmonary koch’s in 2003-04. took complete ATT
  • 73. • She also developed inability to hold her neck with falling to a side in Feb 2009 for which she underwent all investigations and took treatment from Vimhans . • This was more marked when she was emotionally upset or hurt
  • 74. Family history Father • Hypothyroidism • Haemmoroids • D.M. • Asthma • Cholelithiasis
  • 75. Family history • OSTEOARTHRITIS MOTHER • HERPETIC ENCEPHALITISSISTER
  • 76. • Paternal grandfather: Heart problem • Paternal grandmother(died in 2005) D.M. Heart trouble • Maternal grandmother: D.M. Urolithiasis, Cholelithiasis Family history
  • 77. GYNAE AND OBS HISTORY • Menarche: class V (11 yrs) • Cycle had always been regular: 4- 5/ 29-30 • She had pain during menses > hot fermentation; she occasionally took crocin pain relief
  • 78. • She got married in 2006 • Had a son in 2008; FTNVD with episiotomy • No history of abortion/ miscarriage GYNAE AND OBS HISTORY
  • 79. Personal history • Diet : non vegetarian • Occupation: science teacher in a private school
  • 80. Generalities • Appetite: Irregular meal timings post marriage • Thirst was increased from last 4 days since she was feeling short of breath ; desired cold water • Sleep: Slept on sides, esp right ; in dark ; could not sleep alone • Dreams: Had many dreams unremembered
  • 81. • Desired non-veg +++ earlier esp. MUTTON (decreased frequency now as she prayed regularly); Developed liking for sweets since pregnancy which persists even now; always preferred spicy food ; curd • Aversion: fruits +++ Generalities
  • 82. • Bowels: every evening, sometimes even skipped days ; mostly hard stool requiring straining; post episiotomy developed hard stool which were painful sometimes • Urine: Had U.T.I. many times during pregnancy Generalities
  • 83. • Perspiration: not much • T/R: She could not tolerate extremes of temperatures although preferred cold weather Generalities
  • 84. • Born in a middle class family, eldest of 4 sisters. Used to help in all household chores. Cares for all her younger sisters. • Father mostly on tours. Brought up by mother who has always been moody and temperamental especially when husband was touring. Lots of cursing and swearing about there being 4 daughters. Felt unhappy and looked forward for father’s return as he was very nice when around. Life and circumstances
  • 85. • Married to a Govt servant after her studies. • Conflict with MIL and unmarried SIL. Husband’s younger brother was alcoholic and divorcee. Since FIL was not there, her husband had numerous responsibilities and could not move away. • So, three women vying for the attention of her husband!! • Since last two years shuttling between staying at her parent’s place and sometimes staying at her husband’s. • At times husband also moves in with her. Life and circumstances
  • 86. • Mother passes numerous comments at her and her husband, yet she stays! • Does not want to go back yet not happy staying with her mother as well. • If MIL is unwell she always goes back and ensures that she is taken care off. Once well, the bickering starts again. • Believes things may improve if SIL is married off. Life and circumstances
  • 87. Mind and disposition • She desired to be alone • Longs for time to spend with her husband, but always ends up fighting and screaming at him when around (for no reason). • Though takes good care of her son, when upset beats him and then repents. • Irritable, short tempered • Oversensitive • Irresolute and impatient
  • 88. GPE • Weight 55 kgs • BP 110/72 mmHg • Pulse: 94/min • Lid lag sign –ve • O/E: tender LS junction
  • 89. Investigations • 15/2/10 : CECT Head – Hypodense (?) lesion in right frontal region 29/7/11 : NCCT Orbits- WNL
  • 90. Questions for the audience • Is the case taking complete or is something missing? • Which is the book required for prescription? • Is there a need for repertorisation? • How do we frame the totality of symptoms? • What is the remedy to prescribe? • Which potency and remedy repetition?
  • 91. Framing the totality of symptoms • Irresolute, impatient, irritable, short tempered • Contradictory • Desires alone • Aversion to fruits • Desires non-veg especially mutton • Involuntary sighing
  • 92. Ignatia amara • Inconstant, impatient, irresolute, quarrelsome. • Amiable in disposition if feeling well, but easily disturbed by very slight emotion; easily offended. • The slightest fault finding or contradiction excites anger, and this makes him angry with himself. • The remedy of great contradictions • Especially suited to nervous temperament; women of a sensitive, easily excited nature;
  • 93. Ignatia amara • Desires improper things, and cries aloud when they are refused,… • Extremely morose, finds fault, and makes reproaches. • Pressure in the right eye from within outward; it seems as though the eyeball was protruding from the orbit (fifth day) • Great weakness of the whole body; on waking it seems as though his breath would fail,
  • 94. Prescription • 15-9-11 • Ignatia amara LM1 OD
  • 95. Follow up • 5-10-11 • Occasionally feels the need to take a deep breath (on own) • Bowels: daily (first time in her life) • Backache and headaches better • Rx • Ignatia amara LM2 OD
  • 96. Follow up • 30-10-11 • Feels much better • No episode of breathlessness in between • Bowels regular • Pains and aches better • Very happy with her serological report dated 29-10-11 • Weight 56 kgs
  • 97. Follow up • She continued to improve in her symptoms • She also moved back with her inlaws in the month of March and was maintaining a dignified silence without getting very worked up. • Had gained about 5 kgs of weight by May-June 2012 • By May her eyes had also become nearly normal. • TSH report normalised by 29-5-12. Thyroid antibodies normalised by 29-6-12.
  • 98. Case 2: HYPOTHYROIDISM • Mrs. A. , 35 years old consulted first on 29th march 2003. • O/O she was tall, heavy built, having brown eyes, colored hair, gap in upper central incisors, saddle shaped knobby nose with a horizontal linear mark, bunions on feet, bright nail paints.
  • 99. Presenting complaints • She was a K/C/O hypothyroidism since 1985 • Intervertebral disc prolapse since school time • K/C/O migraine since college time • Hoarse voice • B/L Varicose veins in lower limb • Melasma • Constipation
  • 100. HOPC • In 1985, she developed weight gain, low mood, low feeling, hair loss with trembling of hands. • She got her T.S.H. levels done for the first time on the recommendation of her family physician, which were 125 • Since then she has been on Eltroxin
  • 101. • When in class IXth during kickboxing, she fell on her back, hurting it and as a result. • MRI revelaed IVDP • The pain is more in left lumbar region , left hip and left lower limb • It aggravates on lying down and is better by walking • Has been taking numerous pain killers HOPC
  • 102. • K/C/O Migraine since college time. • < left side. • Pain used to start around 3-4 A.M. and aggravate. • Sometimes > vomiting • Popped pain-killers like toffee! HOPC
  • 103. • Has varicose veins since?: feels legs cannot take up her weight • Also, has pain in b/l feet with numerous planter warts, bunions which started from right foot and then came on to left foot. • Developed melasma during 2nd pregnancy. HOPC
  • 104. Past illnesses  Chicken pox in class 2nd Malaria 4-5 times after she was 10 years old  Typhoid in first pregnancy  Recurring U.T.I. post marriage
  • 105. FAMILY ILLNESSES •Alcoholic •Drug addict FATHER •Migraine •R.A. •H.T. MOTHER •Drug addict BROTHER
  • 106. • MATERNAL AUNT - R.A. • MATERNAL GRANDFATHER - Heart trouble FAMILY ILLNESSES
  • 107. Obs & Gynae history Menarche: 12 years Cycle: 4 / 28-30 days Generally feels better if flow is good G2P2A0; both deliveries LSCS
  • 108. Personal history Diet: Eggetarian Married for 14 years No addictions: rare intake (just taste) of alcohol
  • 109. Generalities • Appetite: feels like eating whenever she is depressed; does not feel hungry when is in good mood; during school time she used to throw away her food due to fear of getting rebuked by her mother
  • 110. • Thirst : poor • Desires : Hot food ; green chillies ; water melon (as a child) • Aversion : milk 3+ • Sleep : better when goes to mother’s place ; cannot sleep on back (post trauma) • Dreams : of fire ; explosion ; sometimes make no sense Generalities
  • 111. • Bowels: she has always had a tendency for constipation; would go once in 2-3 days- no urge the other days though she felt heaviness in abdomen. Kayam churna, trifala, isabgol and all other dulcolax etchad failed to improve. • T/R: Always been chilly +++ Generalities
  • 112. Life and circumstances She had a troubled and insecure childhood as her father was an alcoholic and a drug addict. Saw her parents frequently quarreling. Her mother was a very bossy and stern woman who enforced lots of do’s and dont’s for her children particularly about timings and relations as she grew up.
  • 113. Grew up as a headstrong and defiant child who would do contrary to what was told to her (by her mother). In class 8th she got infatuated with a middle aged man and developed sexual relations with him. She also bunked her school many-a-times to have sex with him. This continued until she was in class 10th / 11th when she developed intense guilt of doing wrong. Life and circumstances
  • 114. She said that as her mother did not allow her to talk to boys, she did this in revolt but later became hooked on to it. Some time later, one of her classmates became her boyfriend and she confided in him. (She is today married to him) Life and circumstances
  • 115. After marriage there were many fights and troubles as she had married against the wishes of her family. But the insecurities continued as her husband was also not working. They got financial help from her father-in- law as he was extremely well-off. Life and circumstances
  • 116. She undertook teaching as a profession for her (out of defiance and) self respect and satisfaction. Although there was no issue of money but the insecurities continue. Also worries about her own mother and other family. Life and circumstances
  • 117. Frequent arguments with husband. Also now that her daughter is growing up she is haunted by the fear of her past! Her son is also mildy dyslexic and concern about him. Also worries how her children would react to their father being at home all the time. Life and circumstances
  • 118. • Domineering, haughty, proud • Defiant • Short tempered and strict • Aggressive, must be followed.. • Emotional and caring • Poor in arithmetic calculations • Poor concentration in reading!! • Gloomy at times and then sits alone Mind and disposition
  • 119. GPE • Weight 84 kgs • BP 140/94 mmHg • Pulse: 82/min • O/E: tender LS spine
  • 120. Investigations
  • 121. Questions for the audience • Is the case taking complete or is something missing? • Which is the book required for prescription? • Is there a need for repertorisation? • How do we frame the totality of symptoms? • What is the remedy to prescribe? • Which potency and remedy repetition?
  • 122. Framing the totality of symptoms • Haughty • Domineering • Chilly • Inability to concentrate or study • Backache • Sexuality
  • 123. Guess the remedy • Feeling that she ought to be reverenced by all around her and have great respect paid to her opinions. • Impatient.. • Angry, nothing suits him. • Gloomy…. Discontented all day. • Sexual desire increased.
  • 124. Guess the remedy • Wishes to be alone, unable to settle mind on study. • No desire to study or read in evening. • Inability to read or study ; Inability to concentrate thoughts, with restlessness and discontentment. • Forgetful agg. words when talking ; Forgetful of what he reads.
  • 125. Guess the remedy • Irritable and chilly. Hammering headache, < l. temple. (Boger) • Small of back feels as if it would break. (Hering, Allen etc.)
  • 126. Prescription • 29-3-03 • Rx • Hamamelis LM1 OD
  • 127. Follow up • The first thing to improve was her constipation. Over a period of 3-4 months, her bowels became regular and are so till date. • Her back also improved.. She now can sit on floor, jump around (against my advise!) and can enjoy life without lumbar belt… all of thin in a span of two years. • For last 5-6 years her thyroid reports have been normal. • Also since last 4 years she has been off thyroid allopathic medication.
  • 128. Follow up • Her plantar warts have now fallen off. • Her migraine sill bothers her and is always triggered by stress in life. • Sleep is good, of course if not disturbed by trouble….
  • 129. All of this has been learnt from my esteemed teachers. I must thank them for teaching me all of this and much more.
  • 130. Mischief just seems to follow wherever Dennis appears, but it is the product of good intentions, misdirected helpfulness, good- hearted generosity, and, possibly, an overactive thyroid, ... Hank Ketcham On Dennis the Menace