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‘Love me only, at all times’ – The case of a young woman with hypothyroidism
*Corresponding author: Arun Lalshankar Pandya, MD (Hom), Aastha Homeo Clinic, Akola - 444001, Maharashtra, India. drarunpandya980@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Pandya AL. ‘Love me only, at all times’ – The case of a young woman with hypothyroidism. J Intgr Stand Homoeopathy 2020;3(4):100-3.
Abstract
This case report describes a 23-year-old woman who developed hypothyroidism and sought homoeopathic treatment. In this case, we adopted Kent’s approach as the patient displayed characteristic mental as well as physical general symptoms. Her primary mental characteristics were irritability and hatred toward those who offended her and a persistent feeling of being lonely. Her characteristic physical generals included desire for salt and aggravation by exposure to sunlight. Kent’s approach enabled us to select Natrum mur as the remedy. Thorough analysis and evaluation enable physicians to select the most suitable approach for any given case. This case emphasised the importance of case analysis and evaluation as an integral step after case taking. It also highlights the role of homeopathy in cases of endocrinal disorders and its efficacy in reversing pathological processes.
Keywords
Homoeopathy
Hypothyroidism
Case taking
Kent’s approach
Natrum muriaticum
INTRODUCTION
Homoeopathy is a system of medicine based on individualisation and symptom similarity between the patient and the medicine. A careful review of homoeopathic literature allows us to appreciate the rich clinical as well as therapeutic material with regard to treatment of thyroid disorders.[1] A survey response of 1000 subjects with thyroid disorders, conducted in two cities of Kerala, revealed that 37.83% of the subjects used homoeopathic medicine for their thyroid complaints, 35.15% used modern medicine and 27.02% used Ayurvedic medicines.[2] Studies reveal that in endocrine disorders, homoeopathic medicine acts to stimulate the gland, in cases of deficient secretion and to quiet it in cases of excess secretion. Endocrine disorders such as thyroid disorders are often hereditary or constitutional defects; homoeopathic medicines have a great role in such conditions. In a majority of cases, remedy selection depends on an individual’s totality.[3] There is definite evidence supporting the effectiveness of homoeopathic medicines in stimulating the thyroid gland to produce normal hormone levels.[4]
CASE REPORT
Presenting complaints
Ms. SSP, a 23-year-old woman, had been experiencing exhaustion with weight gain, body ache, lack of interest in daily routine and disturbed sleep, all of which had progressed gradually over a period of 6 months. She also had irregular menses for 1 year; her menses were frequently delayed, often by 2–3 months. Her menstrual flow was moderate with brownish discharge. She also had hair fall with dandruff for 1 year. On examination, she was afebrile. Her pulse was 66/min, BP 120/70 mmHg and weight 60 kg.
Family history: Her mother had hypothyroidism.
Based on the chief complaint and examination results, the patient was diagnosed with hypothyroidism. To confirm the diagnosis, the patient was advised to get her T3, T4 and thyroid-stimulating hormone levels checked [Figure 1].[5]
- Pre-treatment.
Physical generals: Desire-salt++, Aversion-Fish+, meat+
Sun: Aggravating headache+
Thermals: Hot.
Life situation
When the patient was 5 years old, her father separated from the family. As a child, she would feel sad on seeing her friends accompanied by both their parents. She missed her father’s love and presence. As her mother was the sole breadwinner of the family, she could not give the patient the love and attention she demanded. This made her feel very unloved by her mother. The patient has been very irritable since childhood. She always felt that her mother loves her sister more than her. If things do not go her way, she stops talking; if she is working in the kitchen, she reacts by throwing the utensils. She has very few friends and her relationship with them is not good. She has a habit of picking fights with her sister and friends on trivial matters. This attitude made her unpopular at school and college. She tends to argue with her friends, wants everything to go her own way, wants her friends to bend to her will and always say good things about her. She hates being disturbed by her friends when busy.
Selection of approach
The case contains characteristic, qualified mental symptoms and physical generals; hence, Kent’s approach was selected for this case.[6]
Repertorial totality
A/f anger vexation suppressed from
Anger irascibility tendency temper tantrums reprimands after
Anger irascibility talk indisposed to
Offended easily
Craving salt++
Aversion fish++ meat++
Headache < sun exposure+
After repertorisation with the complete repertory, the top five remedies as per their numerical totality are as follows:[7]
Natrum mur: 7/13
Pulsatilla: 5/11
Calc carb: 5/9
China: 5/9
Sulphur: 5/8
The state of sensitivity, especially to reprimands and the individual’s reaction of throwing temper tantrums and anger persisting for a long time, is the central themes of the case. On the basis of physical generals such as desire salt, aversion fish and meat and headache after exposure to sun, Natrum mur comes closer than other remedies. Therefore, the final remedy selected was Natrum mur.
Susceptibility, posology and repetition
At the predisposition level, the patient’s mother has hypothyroidism. The disease manifestation in this case shows a gradual progress with no characteristic physical complaints. The patient shows marked sensitivity at the mental level with prominent dispositional and mental expressions, so the sensitivity is high. The pathology is structurally reversible and the miasm is sycosis. Hence, the susceptibility of the patient is moderate to high. Thus, 200 potency was selected and was repeated infrequently.
Prescription
The patient was prescribed Natrum mur 200, one dose. She was advised to get her thyroid profile evaluated [Figure 1] and follow-up after 15 days. Homoeopathic treatment was continued and patient did thyroid profile and followed up as advised. After 11 months of treatment, the thyroid levels became normal [Figure 2].
- Post-treatment.
Follow-up criteria
The follow up criteria was defined [Table 1] and patient’s progress was charted [Table 2] with reference to the follow up criteria [Table 1].
| Follow-up criteria | Abbreviation and its meaning |
|---|---|
| 1) Weakness and dullness | < = aggravation |
| 2) Irritability | > = amelioration |
| 3) Irregular menses | + = present |
| 4) Sleep | 0 = absent |
| 5) Hair fall | S = same |
| 6) Weight | ↑ = increased |
| 7) Investigation | ↓ = decreased |
| G = Good | |
| C = Changeable | |
| F = Fluctuating | |
| CL = Clear | |
| WNL = Within normal range |
| Date | 1 | 2 | 3 | 4 | 5 | 6 | 7 | Comments |
|---|---|---|---|---|---|---|---|---|
| 10-10-18 | > | > | S | G | > | ↓ –1 kg (59 kg) |
T3: 0.51 ng/mL T4: 3.861 μg/dL TSH: 78.949 μIU/mL |
Natrum mur 200, 1 dose weekly for 2 weeks. Advised to repeat TSH level after 15 days |
| 16-11-18 | > | > | > menses appeared- 26-10-18 |
G | > | S | T3: 88.53 ng/mL T4: 4.65 μg/dL TSH: 25.05 μIU/mL |
SL for 15 days |
| 1-12-18 | G | G | C | G | > | ↓ –1 kg (58 kg) |
Natrum mur 200, 1 dose weekly for 2 weeks. Advised to repeat TSH level | |
| 21-12-18 | G | G | S | G | 0 | S | TSH: 5.92 μIU/mL | Natrum mur 1 M single dose. Advised USG |
| 28-1-19- | 0 | 0 | S | G | 0 | > | USG: WNL | Natrum mur 1 M, 1 dose weekly for 2 weeks |
| 15-3-19 | 0 | 0 | > menses appeared-11-2-19 | G | 0 | > | SL for 15 days | |
| 1-4-19- | 0 | 0 | > | G | 0 | ↓ –1 kg (57 kg) |
SL for 15 days | |
| 14-9-19 | 0 | 0 | 0 | G | 0 | 0 | G. TSH: 2.10 μIU/mL | SL for 15 days |
<: Aggravation, >: Amelioration, 0: Absent, S: Same, ↓ : Decreased, G: Good, C: Changeable, WNL: Within normal range, TSH: Thyroid-stimulating hormone
CONCLUSION
The case report demonstrates the importance of individualised constitutional homoeopathic medicine and its role in reversing the functional disturbance of the thyroid gland. The case report also demonstrates the utility of minimum doses in treatment of hypothyroidism. However, as this is a single case report, further well-designed studies may be taken up to obtain further data that may prove helpful for clinical practice.
Acknowledgment
I take this opportunity to acknowledge my teachers: Dr. Sunil Bhalinge, Dr. Shirish Phansalkar, Dr. Prashant Tamboli and Dr. Devangini Broker from my alma mater – Dr. M. L. Dhawale Memorial Homoeopathic Institute, Palghar, for their support and guidance while presenting this case report at the ICR Mumbai Symposium on Thyroid Disorders (2019).
I express my gratitude to Dr. Anoop Nigwekar and Dr. Nikunj Jani (Dept. of Repertory and Case Taking, MLDMHI) for their guidance and motivation to take time from my clinical practice and publish this case report.
Declaration of patient consent
Patient’s consent not required as patients identity is not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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