Hypothyroidism

Overview of Hypothyroidism

• Women are affected approximately six times more frequently than men.
• Hypothyroidism occurs in about 1 in 4000 newborns
• Neonatal hypothyroidism is due to thyroid gland dysgenesis in 80–85%, are twice as common in girls. [2]

Indian epidemiology then other

Causes of Hypothyroidism

• Iodine deficiency
• TSH deficiency
• Autoimmune- e.g. Hashimoto’s thyroiditis, Spontaneous atrophic hypothyroidism, Graves’ disease with TSH receptor blocking antibodies
• Thyroidectomy
• Drugs- Carbimazole
• Methimazole
• Subacute (in other words; de Quervain’s) thyroiditis
• Post-partum thyroiditis
• Congenital Thyroid aplasia [2]
• Either Absent or ectopic thyroid gland
• Atrophic thyroiditis
• Sheehan’s syndrome
• Hypopituitarism [3]

Classification of Hypothyroidism

Primary Hypothyroidism e.g.

• Problem related with thyroid gland
• Autoimmune hypothyroidism
• Congenital disease
• Drugs i.e.: iodine excess
• Iodine deficiency
• Infiltrative disorders

Secondary Hypothyroidism e.g.

• Problem related with pituitary gland
• Hypopituitarism
• Bexarotene treatment

Tertiary Hypothyroidism e.g.

• Problem related with hypothalamus
• Tumors
• Trauma
• Infiltrative disorders
• Idiopathic [3]

Risk factor of Hypothyroidism

• Endemic iodine deficiency
• Women older than 50 years [2]
• Genetic factors
• Chronic exposure to a high-iodine diet.
• Positive TPO antibodies.[3]

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology of Hypothyroidism

• Genetic and environmental factors and the risk of either autoimmune hypothyroidism or Graves’ disease are increased among siblings.
• Environmental susceptibility factors are poorly defined at present.
• A high iodine intake and decreased exposure to microorganisms in childhood increase the risk of autoimmune hypothyroidism.
• These factors may account for the increase in prevalence over the last two to three decades.
• The thyroid lymphocytic infiltrate in autoimmune hypothyroidism is composed of activated CD4+ and CD8+ T cells as well as B cells.
• Thyroid cell destruction is primarily mediated by the CD8+ cytotoxic T cells, which destroy their targets by either perforin-induced cell necrosis or granzyme B–induced apoptosis.
• In addition, local T cell production of cytokines, such as tumor necrosis factor (TNF), IL-1, and interferon γ (IFN-γ), may render thyroid cells more susceptible to apoptosis mediated by death receptors, such as Fas, which are activated by their respective ligands on T cells.
• These cytokines also impair thyroid cell function directly and induce the expression of other proinflammatory molecules by the thyroid cells themselves, such as cytokines, HLA class I and class II molecules, adhesion molecules, CD40, and nitric oxide.
• Administration of high concentrations of cytokines for therapeutic purposes (especially IFN-α) is associated with increased autoimmune thyroid disease, possibly through mechanisms similar to those in sporadic disease. [3]

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Sign & Symptoms of Hypothyroidism:

Sign i.e.:

• Thyroid gland enlargement
• Weight gain
• Anaemia
• Carotenaemia
• Bradycardia Hypertension
• Delayed relaxation of reflexes
• Dermal myxoedema
• Facial features: for example Purplish lips,Malar flush, Periorbital Oedema, Baggy eyelids [1]

Symptoms i.e.:

• BMR decrease
• Cold intolerance Fatigue
• Feeling of drowsiness
• Dry skin Dry hair
• Menorrhagia
• Constipation
• Carpal tunnel syndrome
• Alopecia
• Aches also pains
• Muscle stiffness
• Deafness [2]
• Minimal sweating
• Growth retardation
• Delayed puberty. [1]

Clinical / Physical Examination For Hypothyroidism

• The clinical presentation depends on the duration and severity of the hypothyroidism.
• A consequence of prolonged hypothyroidism is the infiltration of many bodies’ tissues
• Compression of the median nerve at the wrist (e.g. carpal tunnel syndrome).
• Infiltration of the dermis gives rise to nonpitting Oedema (i.e. myxoedema), which is most marked in the skin of the hands, feet and eyelids
• Facial pallor due to vasoconstriction and anaemia
• A lemon-yellow tint to the skin caused by carotenaemia. [3]

Diagnosis of Hypothyroidism

• Blood TSH and freeT4 level with symptoms present.
• Serum cholesterol is usually high in primary hypothyroidism but less so in secondary hypothyroidism.[4]

Differential Diagnosis of Hypothyroidism

• Thyroid carcinoma
• Anemia
• Obstructive sleep apnea
• Dementia
• Adrenal insufficiency
• Vitamine D deficiency
• Lyme disease [5]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Hypothyroidism

• Thyroid function test
• Primary hypothyroidism: Low free T3 and T4 level, Elevated TSH level
• Secondary hypothyroidism: Low free T3 and T4 level, also decrease TSH level
• Electrocardiogram (in other words, ECG): Sinus bradycardia with low-voltage complexes also ST segment-wave abnormalities [2]

Treatment of Hypothyroidism

L-Thyroxine, adjusted until TSH levels are in midnormal range

Levothyroxine replacement:

• To start with a low dose of 50 µg per day for 3 weeks
• Increasing thereafter to 100 µg per day for a further 3 weeks
• Finally, to a maintenance dose of 100–150 µg per day.

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Homeopathic Treatment of Hypothyroidism

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Hypothyroidism:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

Thyroidinum:

• Generally; Thyroid produces anaemia, emaciation, muscular weakness, sweating, headache, nervous tremor of face also limbs, tingling sensations, paralysis.
• In myxoedema also cretinism its effects are striking.
• Moreover; thyroid exercises a general regulating influence over the mechanism of the organs of nutrition, growth and development.
• Excessive obesity.
• Marked sensitiveness to cold, hypothyroidism. Additionally; Easy fatigue, weak pulse, tendency to fainting, palpitation, cold hands and feet, low blood pressure, chilliness and sensitive to cold.
• Worse – especially least exertion, cold, stooping, On the other hand Better – lying on abdomen, or reclining position.[7]

Calc carb:

• Impaired nutrition being the keynote of its action, the glands, skin, also bones, being instrumental in the changes wrought. Basically, Pituitary and thyroid dysfunction. Goitre.
• Furthermore, Difficult swallowing.
• Submaxillary glands swollen. Besides this, Subjects take cold easily; children who grow fat, are large-bellied, with large head, pale skin.
• Averse to work or exertion.
• Headache with cold hands also feet. In detail Constipation; stool at first hard, then pasty, then liquid.[7]
• Worse – pressure specifically of cloths, change weather to cold, exertion, bathing, full moon; whereas Better – Dry climate also weather, After breakfast.[6]

Conium:

• Enlarged glands. Additionally, Engorges and indurates the glandular system, altering its structure like scrofulous and cancerous conditions.
• In brief; Frequent urge to pass stool; hard with tenesmus.
• Worse – from taking cold, either bodily or mental exertion On the other hand; Better – Letting affected part hang down. Stooping. Moving, walking. In the sun. Dark. Pressure. Walking bent. especially On sitting down. Fasting.

Doryphora:

• Hypothyroidism
• Red bloated face with protruding eyes.
• Throat raw and dry, burning.
• Loss of appetite, great thirst.
• Pain in spleen also bowels.
• Morning diarrhoea.
• Great trembling in extremities.
• Besides this; Swelling of body.
• Difficult micturition.
• Worse – warm room, smoking, eating also drinking [pain in bowels] but Better – open air.

Baryta carb:

• Specially indicated in infancy also old age.
• This remedy gives aid to scrofulous children, especially if they are backward mentally and physically, are dwarfish, do not grow and develop, have scrofulous ophthalmia, swollen abdomen, especially take cold easily.
• Always have swollen tonsils.
• Affects glandular structures, and useful in general degenerative changes. Besides this; Submaxillary glands and tonsils swollen.
• Difficulty swallowing; Constipation, with hard, knotty stools.
• Worse – food, On the other hand Better – liquids.

Spongia:

• Children with fair complexion, lax fibre; additionally swollen glands.
• Exhaustion and heaviness of the body after slight exertion.
• Anxiety also difficult breathing.
• Bursting headache.
• Thyroid gland swollen
• Sore throat
• worse – after eating sweet things, specifically on Exertion. Raising the arms. Before 12 p.m.
• Better -Lying with head low, either Eating or drinking, Warm things.

Phosphorus:

• Generally, Effects of iodine and excessive use of salt.
• Produces a picture of destructive metabolism.
• Phosphorus irritates, inflames also degenerates mucous membranes, irritates and inflames serous membranes, disorganises the blood, causing fatty degeneration of blood vessels also every tissue and organ of the body.
• Chronic congestion of the head.
• Brain fag. Additionally, Itching of the scalp, dandruff, falling out of hair in large bunches.
• In detail, Stools, long, hard, difficult to expel. Haemorrhoids.
• Great drowsiness, especially after meals.
• Worse – talking; touch Morning and evening, especially left side, cold On the other hand; Better – Eating, Sleep, Rubbing. [7]

Diet & Regimen of Hypothyroidism

• Focus on balance diet
• Take food: e.g. Fruits, Vegetable
• Healthy fat
• Proteins
• Avoid goitrogenic foods
• Uncooked vegetables: e.g. Cabbage, Broccoli, Cauliflower.

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References use for Article Hypothyroidism

[1] Golwala’s Medicine for student 25th edition 2017

[2] Davidsons Principles and Practice of Medicine (PDFDrive.com)

[3] Harrisons Principles of Internal Medicine

[4] The Merck Manual

[5]https://www.psychiatrictimes.com/view/hypothyroidism-important-diagnostic-consideration-psychiatrist

[6] Concise Materia Medica of Hom. Remedies By S.R. Phatak

[7] Homoeopathic Body-System Prescribing – A Practical Workbook of Sector Remedies

Frequently Asked Questions

What is Hypothyroidism?

Clinical condition resulting from reduced production of thyroid hormone.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Hypothyroidism?

• Thyroidinum
• Calc carb
• Conium
• Doryphora
• Baryta carb
• Spongia

What is the cause of Hypothyroidism?

• Iodine deficiency
• TSH deficiency
• Autoimmune
• Thyroidectomy
• Drugs- Carbimazole
• Methimazole
• Subacute thyroiditis
• Post-partum thyroiditis
• Congenital Thyroid aplasia

What are the symptoms of Hypothyroidism?

• Thyroid gland enlargement
• Weight gain
• Anaemia
• Carotenaemia
• Bradycardia Hypertension
• BMR decrease
• Cold intolerance Fatigue
• Feeling of drowsiness
• Dry skin Dry hair

Give the types of Hypothyroidism?

• Primary Hypothyroidism
• Secondary Hypothyroidism
• Tertiary Hypothyroidism