A case of hyperthyroidism treated with individualised homoeopathic medicine: A case report

INTRODUCTION

Hyperthyroidism is a pathological disorder in which overproduction and secretion of excess thyroid hormone from the thyroid gland, mainly thyroxine (T₄) or both triiodothyronine (T₃) and T_4, occurs. Hyperthyroidism increases with age and is more frequently seen in women. In an epidemiological study from Cochin, subclinical and overt hyperthyroidism was present in 1.6% and 1.3% of subjects participating in a community survey.^[1] In another hospital-based study of women from Pondicherry, subclinical and overt hyperthyroidism were present in 0.6% and 1.2% of subjects.^[2] The most common cause of hyperthyroidism is Graves’ disease, followed by toxic nodular goitre. In this condition, the patient presents with constitutional symptoms of weight loss, fatigue, heat intolerance, increased appetite, palpitations, hot flushes, anxiety and restlessness, muscle weakness, tremors, and oligomenorrhoea in females, sometimes exophthalmos. The patient may develop cardiac complications; therefore, it is important to recognise and treat the symptoms early. In the conventional method, antithyroid drugs, and radioactive iodine are prescribed, and sometimes, thyroidectomy (complete removal) or lobectomy (removal of part of the thyroid gland) is often advised.

Homoeopathy, although efficient in treating thyroid disorders, does not have enough evidence for treatment of hyperthyroidism. Evidence in this respect is both positive^[3-5] and negative.^[6] Apart from this, there are only a few successfully treated case reports available^[7-12] in scientific literature. Few papers even reported the use of homoeopathy medicines as a cause of thyrotoxicosis.^[13-15] In view of the conflict-ridden findings, more and more reporting of such cases become important to draw a definitive conclusion. Here, a case of hyperthyroidism successfully treated with homoeopathic constitutional medicine has been presented to throw some light on this area. To assess the improvement, levels of T3 and T4 and a ‘patient-centred’ outcome scale, i.e., Measure Yourself Medical Outcome Profile 2, was used.^[16] A modified Naranjo criterion was also used to assess causal attribution between the cause and effect that the improvement in each case resulted due to individualised homeopathic medicines and not due to any other causes.

CASE REPORT

A 31-year-old married woman came to the outpatient department of the Regional Research Institute for Homoeopathy, Agartala, on February 24, 2020, with a complaint of irregular menses, frequent headache, fatigue, and weakness.

The patient had complained of irregular menses for the past 3 years. Her menses were mostly delayed and scanty, with slight pain in her abdomen on the 1^st day only. For these complaints, she took home remedies on and off. For the past 6 months, she started having frequent headaches in the temporal region, bursting type mostly after arguments with in-laws and better by sleep. Gradually, she developed weakness and fatigue easily during household work. She does not share her problems with anyone and used to cry a lot when alone.

Her appetite was moderate, with an increased thirst for large quantities. Stools were regular, semisolid, sometimes twice a day. Her urine was normal, with no complaints. The tongue was slightly white-coated and moist. Perspiration was profuse on the slightest exertion. She had a moderate desire for sweets and salty things. The thermal reaction was hot.

Menses started at the age of 12 years, regular periods with 5-day duration with moderate flow. For the past 3 years, her periods were delayed, lasting for only 2 days with dark and clotted blood. The last menstrual period is January 6, 2020. On further interrogation, the patient said that she got married 1 year back, and her in-laws used to scold her as she was unable to conceive even after 1 year of marriage. The patient was sad and melancholic because her marriage was difficult and delayed, and now she is not able to conceive a child either. She had frequent fights with her husband, who was not supportive and denied medical checkup.

Timeline

Timeline of case is mentioned as Timeline of events, as shown in Figure 1.

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Figure 1:

Timeline of events.

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Diagnostic assessment

Complete blood count, thyroid profile test including Free T3, T4 and Thyroid peroxidase antibodies, and ultrasonography (USG) (whole abdomen) were advised after thorough case taking. Where blood count and USG did not reveal any abnormality, her thyroid profile was deranged (T₃ – 254 ng/dL, T₄ – 15 mg/dL, thyroid-stimulating hormone - 0.05 mlU/mL) [Figure 2], and the patient was diagnosed with hyperthyroidism. Further investigations could not be done on account of the inability of the patient to bear expenses.

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Figure 2:

Before treatment.

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Therapeutic intervention

A detailed case taking was done as per Hahnemannian guidelines of case taking given in the Organon of Medicine. Due to the predominance of general symptoms, repertorisation was done according to the Kentian method using Hompath [Zomeo 3.0]. Medicines with the highest marks were Natrum Muriaticum, Sulphur, Sepia, Phosphorus, etc. Natrum Muriaticum was selected because the patient was depressed, introvert, wants to be alone to cry, which goes in favour of Natrum Muriaticum, so the treatment was started with a single dose of Natrum Muriaticum 30. The potency was changed based on the assessment of symptom/sign improvement in accordance with the principles of Organon of Medicine. The patient was followed up telephonically regularly for 1 year with no complaints. Details of follow-ups are given in Table 1.

Table 1: Follow-up and outcomes.

S. No.	Date	Observation	Prescription and advice
1.	10/2/2020	Irregular menses, frequent headache, easy fatigue, and weakness. LMP – January 1, 2020	Natrum Muriaticum 30/1 dose stat Saclac 30 TDS for 2 weeks Adv: CBC, USG (whole abdomen), Thyroid profile
2.	24/2/2020	SQ. The potency of the same medicine increased. CBC: Within normal limits USG: Nothing abnormal detected Thyroid profile: T3-254 ng/dL; T4-15 mg/dL; TSH-0.05 mlU/mL;	Natrum Muriaticum 200/1 dose stat. Saclac 30 TDS for 2 weeks.
3.	6/3/2020	Severe headache once since last visit with intense fatigue. Had to take a painkiller. For initial aggravation, a placebo was given. LMP – February 28, 2020, with the dark, clotted, scanty flow, which lasted for only 3 days.	Saclac 30 TDS for 2 weeks.
4.	18/3/2020	Headache again for 3 days. Fatigue and weakness are the same. LMP – March 7, 2020, recurrence of symptoms; hence, the potency of the same medicine was raised.	Natrum Muriaticum 1 M/1 dose stat. Saclac 30 TDS for 1 month.
5.	21/5/2020	No headache since the last visit. Weakness and fatigue are much better. LMP – April 10, 2020, lasted for 4 days. Patient improving, placebo repeated.	Saclac 30 TDS for 1 month. Adv: Thyroid profile.
6.	20/6/2020	No headache. Weakness and fatigue are almost gone. LMP – May 11, 2020, lasted for 4 days. Thyroid profile: T3-171 ng/dL T4-10.70 mg/dL TSH-3.6005 mlU/mL Patient improving, placebo repeated.	Saclac 30 TDS for 1 month
7.	5/8/2020	Menses regular. No other complaints.	Saclac 30 TDS for 1 month.

CBC: Complete blood count, USG: Ultrasonography, TSH: Thyroid-stimulating hormone, T₃: Triiodothyronine, T₄: Thyroxine, LMP: Last menstrual period, TDS: Thrice a day

Repertorisation chart has been shown in Figure 3.

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Figure 3:

Repertorisation chart.

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The final outcome and possible causal attribution of the changes in this case were assessed using the ‘Modified Naranjo Criteria’ as proposed by the HPUS Clinical Data Working Group (December 2015) [Table 2].^[17] The total score of outcome in this case was 9, which was close to the maximum score of 13 as per the Modified Naranjo Criteria.

Table 2: Assessment by modified Naranjo Criteria score.

Item	Yes	No	Not sure/N/A
1. Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed?	+2	-	-
2. Did the clinical improvement occur within a plausible time frame relative to the drug intake?	+1	-	-
3. Was there an initial aggravation of symptoms?	+1	-	-
4. Did the effect encompass more than the main symptom or condition, i.e., were other symptoms ultimately improved or changed?	+1	-	-
5. Did overall well-being improve?	+1	-	-
6. (A) Direction of cure: did some symptoms improve in the opposite order of the development of symptoms of the disease?	-	0	-
(B) Direction of cure: did at least two of the following aspects apply to the order of improvement of symptoms - from organs of more importance to those of less importance - from deeper to more superficial aspects of the individual - from the top downwards	-	0	-
7. Did old symptoms (defined as non-seasonal and non-cyclical that were previously thought to have resolved) reappear temporarily during the course of improvement?	-	0	-
8. Are there alternate causes (other than the medicine) that with a high probability – could have caused the improvement? (consider a known course of disease, other forms of treatment, and other clinically relevant interventions)	-	+1	-
9. Was the health improvement confirmed by any objective evidence? (e.g., laboratory test, clinical observation, etc.)	+2		-
10. Did repeat dosing, if conducted, create similar clinical improvement?	-	0	-
Total		9

N/A: Not applicable

The patient showed gradual improvement in above mentioned symptoms after the prescription of Natrum Muriaticum, with slight initial aggravation at the beginning of treatment. There was a significant improvement in the symptoms related to hyperthyroidism, like pain in the head, fatigue, and anxiety resolved completely in 6 months duration along with improvements in pathological reports [Figure 4]. The patient’s few other symptoms, such as headache and oligomenorrhoea were also better after taking treatment along with the main presenting complaint. The patient was observed for 1 year without any recurrence of symptoms.

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Figure 4:

After treatment.

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DISCUSSION

In this case, Natrum Muriaticum 30, 200, 1 M potencies were prescribed, which covered the totality of symptoms of the patient and it has shown positive results. The patient was fine, and no symptoms recurred for near about of 1 year after completion of the treatment.

Homoeopathy has good evidence in treating hypothyroid disorders, but when it comes to hyperthyroidism evidence is scarce. One of the reasons may be less number of reports due to difficulty in getting antibody assays tested. In this case, also, free T₃ and T₄ were also advised, but the patient showed her inability to bear the expenses of further investigations, so treatment was started with the limited available information. This limitation is accepted in the present case report also, but it supports the phrase said by Hahnemann, ‘Cessat effectus cessat causa,’ i.e., remove the effects, and you remove the disease, the cause of the effects. Further, to overcome this difficulty, patient-reported outcome measures like the Waynes index^[18] can be used, which are comparable to the results of biochemical investigations for diagnosis of hyperthyroidism. In this case, although the cause of the syndrome was not known and the medicine was prescribed solely on the basis of the totality of symptoms, it acted restorative, relieving all the signs and symptoms of the patient and correcting the thyroid profile of the patient also. There are many case reports where Natrum Muriaticum was used to treat hypothyroidism successfully; this case report is an attempt to show the effect of Homoeopathy on hyperthyroidism, also which favours that Homoeopathy treats the patient in disease and not the disease. Where considerable research is being done on hypothyroidism, hyperthyroidism is still an unexplored area with only a few case reports and animal trials. Documentation of scientific evidence in this condition even becomes more important when, on account of scarce evidence; homoeopathic medicines are held accountable for being the reason for inducing hyperthyroidism.^[13-15] But as the contribution of case reports in generating evidence is limited, clinical trials with larger sample size and better study designs are warranted.

CONCLUSION

Homoeopathy has moved considerably forward in proving its efficacy in treating hypothyroidism, but in hyperthyroidism, it is lagging behind. Where few animal trials could still be found, trials on human participants are none. Although few preliminary evidences in the form of case reports are found, there is a further need to conduct clinical trials with larger sample sizes as well as to document more scientific evidence to generate the data.