Successful discontinuation of levothyroxine in a known case of hypothyroidism through personalised homoeopathic treatment: An evidence-based case report

INTRODUCTION

Hypothyroidism (International Classification of Diseases (ICD)-11 code: 5A00) is a prevalent endocrine disorder characterised by insufficient thyroid hormone production, which results in a range of clinical manifestations due to a low metabolic rate.^[1] This condition commonly affects women and older individuals; primary hypothyroidism is the most common.^[2] In India, the prevalence of hypothyroidism is approximately 11% among the adult population, making it one of the most common thyroid disorders.^[3] Typical symptoms include fatigue, weight gain, cold intolerance, dry skin and a general feeling of lethargy, all of which significantly impact a patient’s quality of life.^[4]

The diagnosis of hypothyroidism is primarily based on thyroid function tests, where elevated levels of thyroid-stimulating hormone (TSH) and low levels of free T4 are indicative of overt hypothyroidism.^[5] The standard treatment for hypothyroidism involves lifelong levothyroxine therapy, which effectively normalises thyroid hormone levels and improves symptoms in most patients. However, a subset of patients continues to experience persistent symptoms, despite adequate replacement therapy.^[6]

In recent years, alternative therapeutic approaches such as homoeopathy have been investigated as adjunct or complementary treatments for hypothyroidism. Some case reports suggest that individualised homoeopathy may alleviate symptoms and potentially normalise thyroid hormone levels. In addition, a few open-label, prospective, single-arm clinical trials and exploratory randomised-control studies have reported improvements in both clinical symptoms and TSH levels following homoeopathic interventions.^[7-13]

This case report demonstrates the successful management of overt hypothyroidism using personalised homoeopathic medicine, adhering to the HOM-CASE guidelines.^[14] The causal attribution of clinical outcomes was evaluated using the modified Naranjo criteria for assessing causal attribution (MONARCH),^[15] along with improvements in TSH levels and significant weight reduction during treatment. These findings suggest the potential of homoeopathy as a complementary or alternative therapy for managing hypothyroidism. However, to draw definitive conclusions on the effectiveness of homoeopathy in patients already receiving allopathic hormonal replacement therapy, large-scale studies with statistically powered sample sizes and rigorous study designs are needed.

CASE REPORT

Diagnostic findings

After the initial consultation, she was advised to undergo a thyroid function test. The reports are provided in Figure 1.

Close

Figure 1:

Baseline thyroid profile of the patient dated 21^st Nov, 2023.

Export to PPT

Intervention

A totality of symptoms, including characteristic mental and physical general symptoms, was constructed in accordance with Kent’s philosophy to guide the intervention.

Based on the repertorial totality [Table 1 and Figure 2], the following remedies were identified with their corresponding totality scores and ranking:

Table 1: Conversion of patient symptoms into homoeopathic rubrics.

S. No.	Symptoms	Rubrics
Mental general
1.	Ailments from disappointment.	Mind, ailments from, disappointment
2.	Suppressed anger	Mind, ailments from, anger, suppressed
3.	Reserved.	Mind, reserved
Physical general
4.	Desire for salty things.	Generals, food and drinks, salt, desire
5.	Thirst for large quantities of water.	Stomach, thirst, large quantities, for
6.	Headache from exposure to sunlight.	Head, pain, sun, exposure to sun, from
Particulars
7.	Severe hairfall	Head, hair, falling
8.	Gradual increase in weight	Generals, obesity

Close

Figure 2:

Reportorial sheet of patient symptoms with corresponding homoeopathic rubrics.

Export to PPT

• Natrum muriaticum – 8/23

• Phosphorus – 8/18

• Ignatia – 7/13

• Cocculus – 7/9.

Following repertorisation and referring to the Homoeopathic Materia Medica, Natrum muriaticum was selected as the indicated remedy. The selection was based on its alignment with the patient’s mental and physical general symptom, particularly the presence of ailments associated with disappointment and suppressed anger, which are characteristic of Natrum muriaticum. In addition, the patient’s hot thermal disposition further confirmed the suitability of this remedy.^[13,14]

Other remedies, such as Ignatia, Phosphorus, Veratrum album, and Cocculus indicus, were excluded because they are considered chilly remedies and did not align with the patient’s thermal constitution. The prescription of Natrum muriaticum was guided by the repertorial analysis and supported by the patient’s mental and physical characteristics, ensuring precision in remedy selection.

Considering the patient’s sedentary lifestyle and desk job, Natrum muriaticum 200 was selected in alignment with the principles outlined in the Posology chapter.^[15] The medicine, procured from SBL Pvt. Ltd., was dispensed in the form of four pills per dose from the homoeopathic dispensary.

Follow-up and outcome

Over a 1-year follow-up period [Table 2], the patient’s TSH levels showed significant improvement with the prescribed treatment. Hormonal replacement therapy (levothyroxine 50 mcg) was gradually tapered over 6 weeks – initially taken on alternate days for 2 weeks, then every 3^rd day for the next 2 weeks and finally once a week for 2 weeks – before discontinuing it entirely. During this period, the patient was advised to avoid goitrogenic foods, such as soy products, cruciferous vegetables (e.g., broccoli, cauliflower and cabbage) and millet.

Table 2: Follow-up.

Date of follow-up	Symptoms	Prescription	Justification of prescription
18 November 2023	The patient presented with gradual weight gain over the past 6 months and hair fall for the past year. She was diagnosed with hypothyroidism one year ago and has been on levothyroxine 50 mcg. Despite continued medication, her symptoms persisted, leading her to consider discontinuing levothyroxine. A baseline thyroid profile revealed a TSH level of 6.7 µIU/mL.	1. Natrum muriaticum 200C/3 dose O.D×3 days in sugar of milk 2. Placebo/BD/28 days.	The remedy was prescribed based on symptom totality, referral to the materia medica and adherence to posology principles for accurate potency and dosage selection.[16-18]
28 December 2023	No significant improvement; advised DASH diet, physical exercise and avoidance of goitrogenic foods.	1. Placebo/BD/21 days	Placebo prescribed with dietary and lifestyle recommendations.
18 January 2024	Weight loss observed; reduced hair fall; advised gradual tapering of Levothyroxine 50 mcg.	1. Placebo/BD/21 days	Placebo continued as improvement observed.
06 February 2024	Further improvement in hair fall and weight.	1. Placebo/BD/28 days	Placebo continued as improvement sustained.
28 February 2024	Continued improvement in symptoms.	1. Placebo/BD/28 days	Placebo continued as the case improves
20 March 2024	Further improvement noted.	1. Placebo/BD/21 days	Placebo continued as the case improves
12 April 2024	Mild hair fall, unsatisfactory bowel movements; advised thyroid profile test.	1. Placebo/BD/21 days	Placebo continued; patient instructed to bring thyroid test report
03 May 2024	No change; patient did not undergo thyroid test, re-advised.	1. Placebo/BD/21 days	Placebo continued; thyroid profile test re-recommended
22 May 2024	Hair fall persists; TSH elevated (27.9 mIU/L); advised strict dietary and lifestyle modifications.	1. Natrum muriaticum 200C/3 dose O.D×3 days in sugar of milk 2. Placebo/BD/21 days	Repeated Natrum muriaticum based on elevated TSH level and persistent symptoms
12 June 2024	Hair fall improved; significant weight loss due to diet and exercise; advised TSH re-investigation by next month.	1. Placebo/BD/21 days	Placebo continued as the case improves
03 July 2024	Further improvement; reminder given for thyroid function test.	1. Placebo/BD/21 days	Placebo continued as the case improves
26 July, 2024	TSH significantly improved (7.398 µIU/mL)	1. Placebo/BD/21 days	Placebo continued as the case improves
16 August 2024	Old complaints improving.	1. Placebo/BD/21 days	Placebo continued as the case improves
06 September 2024	Further improvement	1. Placebo/BD/21 days	Placebo continued as the case improves
27 September 2024	Marked weight reduction; advised thyroid function test to correlate clinical and serological improvement.	1. Placebo/BD/21 days	Placebo continued as the case improves
14 October 2024	TSH normalised (3.7285 µIU/mL); significant weight loss (from 70.8 kg to 61.2 kg); advised to continue healthy lifestyle.	1. Placebo/BD/21 days	Placebo prescribed due to clinical improvement and normalisation of thyroid markers

OD: Once daily, BD: Twice daily, TSH: Thyroid stimulating hormone, IH: Individualised homoeopathy, DASH: Dietary adjustment for controlling weight and hypothyroidism

After discontinuing levothyroxine, the patient’s TSH levels temporarily increased to 27.9 mIU/L [Figure 3]. However, with continued treatment and dietary guidance, her TSH levels gradually decreased to 7.398 µIU/mL [Figure 4]. Over time, with sustained treatment and adherence to dietary advice, her TSH levels normalised to 3.728 µIU/mL [Figure 5].

Close

Figure 3:

Thyroid profile levels of patient dated 21.05.2024.

Export to PPT

Close

Figure 4:

Thyroid profile levels of patient dated 26.07.2024.

Export to PPT

Close

Figure 5:

Thyroid profile levels of patient dated 08.10.2024.

Export to PPT

The patient was advised to regularly monitor her weight and maintain it within a healthy range. Over the course of the treatment, her weight decreased from 70.8 kg to 61.2 kg, as shown in Table 3. This weight reduction was achieved without any accompanying symptoms and was accompanied by a marked improvement in her overall well-being.

Table 3: Assessment of weight changes during the course of treatment.

S. No.	Date of weight assessment	Weight (in Kg)
1.	18 November 2023	70.8 kg
2.	28 December 2023	69.2 kg
3.	18 January 2024	68.3 kg
4.	06 February 2024	67.3 kg
5.	28 February 2024	66.5 kg
6.	20 March 2024	65.8 kg
7.	12 April 2024	65.4 kg
8.	03 May 2024	66.2 kg
9.	22 May 2024	67.0 kg
10.	12 June 2024	66.2 kg
11.	03 July 2024	65.0 kg
12.	26 July 2024	64.2 kg
13.	16 August 2024	63.5 kg
14.	06 September 2024	62.7 kg
15.	27 September 2024	61.6 kg
16.	14 October 2024	61.2 kg

The modified Naranjo criteria score is + 8, indicating a positive cause-and-effect relationship between the homoeopathic medicine given to the patient and the positive outcome [Table 4].

Table 4: Post-intervention modified Naranjo score.

Domain	Patient answer	Score
1. Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed?	Yes	+2
2. Did the clinical improvement occur within a plausible timeframe relative to the medicine intake?	Yes	+1
3. Was there a homoeopathic aggravation of symptoms?	No	0
4. Did the effect encompass more than the main symptom or condition (i.e., were other symptoms, not related to the main presenting complaint, improved or changed)?	Yes	+1
5. Did overall well-being improve? (Suggest using a validated scale or mention about changes in physical, emotional, and behavioural elements)	Yes	+1
6 A. Direction of cure: Did some symptoms improve in the opposite order of the development of symptoms of the disease?	Not sure	0
6B. Direction of cure: Did at least one of the following aspects apply to the order of improvement in symptoms: –from organs of more importance to those of less importance? –from deeper to more superficial aspects of the individual? –from the top downwards?	Not sure	0
7. Did ‘old symptoms’ (defined as non-seasonal and non-cyclical symptoms that were previously thought to have resolved) reappear temporarily during the course of improvement?	Not sure	0
8. Are there alternative causes (i.e. other than the medicine) that – with a high probability – could have produced the improvement? (Consider known course of disease, other forms of treatment and other clinically relevant interventions)	No	+1
9. Was the health improvement confirmed by any objective evidence? (e.g. investigations and clinical examination)	Yes	+2
10. Did repeat dosing, if conducted, create similar clinical improvement?	Not sure	0

Total score= +8

DISCUSSION

This case report highlights the potential role of individualised homoeopathy treatment in managing primary hypothyroidism and facilitating the gradual discontinuation of levothyroxine therapy. The patient, initially diagnosed with hypothyroidism and on levothyroxine therapy, exhibited significant clinical improvement in thyroid function following homoeopathic intervention. Structured tapering of levothyroxine over 6 weeks, combined with dietary modifications (particularly avoiding goitrogenic foods), normalised the TSH levels. While an initial temporary rise in TSH level (27.9 mIU/L) was observed after discontinuation, it eventually stabilised at 3.728 µIU/mL. In addition, the patient’s weight reduced from 70.8 kg to 61.2 kg, with no recurrence of symptoms, such as hair loss.

Autoimmune hypothyroidism, particularly Hashimoto’s thyroiditis, is known for causing fluctuating TSH levels, the level changes from significantly elevated values to normalisation due to episodic thyroid inflammation and immune activity. In such cases, autoimmune markers, such as anti-thyroid peroxidase and anti-thyroglobulin antibodies, typically provide diagnostic confirmation. However, in this case, the patient did not exhibit the hallmark characteristics of autoimmune thyroiditis. There were no reported clinical signs of thyroid inflammation (e.g., tenderness and swelling), and there was no history of fluctuating hypothyroid symptoms prior to levothyroxine initiation. Furthermore, the patient’s progressive and sustained improvement in thyroid function, weight reduction and symptom resolution with homoeopathic management suggests a non-autoimmune aetiology of her hypothyroidism.

While these findings suggest a possible role of homoeopathy in supporting thyroid function and alleviating symptoms of hypothyroidism, the absence of a control group limits the generalizability of these results. Larger, randomised studies are needed to validate the efficacy of homoeopathic treatment in hypothyroidism management and to determine whether such an approach can sustainably reduce dependence on hormone replacement therapy.

CONCLUSION

This case report highlights the potential of Individualised homoeopathy (IH) in managing hypothyroidism, demonstrating significant improvements in thyroid function and symptom relief. The patient’s successful tapering of levothyroxine, alongside homoeopathic intervention and dietary modifications, resulted in normalised TSH levels and weight reduction, with sustained well-being. While further studies with larger sample sizes and controlled designs are needed, this case provides valuable evidence to the growing interest in homoeopathy as a complementary treatment for thyroid dysfunction, suggesting its potential role in reducing dependence on conventional hormone replacement therapy.