The scope of ultra-diluted medicines in cases of Vitamin D deficient Hashimoto thyroiditis

INTRODUCTION

Hashimoto thyroiditis (HT) is an autoimmune disease that is a predominant cause of hypothyroidism.^[1] HT was initially wrongly believed to be a rare disease. However, recently, HT has been discovered to be a common disease that is treated only in case of complications. The incidence is estimated at 3.5 in every 1000/year in women and 0.8 in every 1000/year in men.^[2]

Coastal areas such as the Kanniyakumari district report more cases of hypothyroidism.^[3] The chief investigation for assessing HT is determining the level of antithyroid peroxidase antibody (TPOAb) in the blood. A cross-sectional survey in the coastal areas of Kerala shows TPOAb elevation in 46.3% of people with thyroid dysfunction.^[4]

Vitamin D is a fat-soluble vitamin; 90% of human requirement is synthesised in the skin on exposure to ultraviolet B radiation. It has very few dietary sources. Vitamin D deficiency is equally present in sunny and damp areas. Hospital-based studies state that Vitamin D deficiency ranges from 37% to 99% among the population.^[5] Vitamin D has immunomodulatory properties and its deficiency increases the risk of HT.^[6] Vitamin D exerts its effect by binding to its receptor; estimation of 25-hydroxyvitamin D₃ level is the most common method of determining the Vitamin D level.^[7] Conventionally, the synthetic form of Vitamin D is administered on a weekly basis to increase the levels.

A recent study showed a potential relationship between Vitamin D level and HT, particularly in people with 25(OH)D₃ levels lower than 20 ng/mL. The mechanism for this association and whether it is a cause or result relationship is not clear.^[6] The Zulewski clinical score is used to assess symptomatic improvement in cases of hypothyroidism.^[8]

In homoeopathy, medicines are used in their dynamised form; they are diluted with alcohol and put through a certain physical process to increase the potency. The CM, LM and M potencies of homoeopathic medicines are referred to as ultra-dilutions as they undergo a much higher number of dilutions.

A case report from the endocrinology outpatient department of the National Homoeopathy Research Institute in Mental Health, Kottayam, showed reduction in TPOAb levels after the administration of homoeopathic medicine.^[9] This study aimed to determine the scope of homoeopathic treatment in patients with HT and Vitamin D deficiency cases by improving 25(OH)D₃ and TPOAb levels.

MATERIALS AND METHODS

In this experimental study, 20 female patients presenting with the symptoms of hypothyroidism and elevated levels of thyroid-stimulating hormone and thyroid antibodies were selected from the outpatient department of SKHMC, Kulasekharam, Kanniyakumari District. We included only female patients in this study as the prevalence of HT with low Vitamin D levels is greater in women than in men.

RESULTS

Each patient was prescribed medication based on their individualised symptoms [Table 1].

The socioeconomic statuses and occupational details of the patients are mentioned in [Tables 2 and 3], respectively.

Patients between the age group of 31 and 40 are affected more compared to the other age groups [Table 4].

The details of the prescribed remedies are provided in [Figure 1]. Natrum mur, Calcarea carb, Phosphorus, Calcarea iod, Lycopodium, Lachesis, Sepia, Spongia and Ignatia were the most commonly prescribed remedies, in decreasing order.

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Figure 1:

Distribution of cases according to the prescribed remedy.

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The 50 millesimal potency was prescribed in the most cases, 12 (60%), 200 C in 4 cases (20%) and 30 C and 1 M in 2 cases each (10%).

When the Zulewski score is used to assess symptomatic improvement in HT, a score below 3 indicates marked improvement, 4–6 moderate improvement, 7–9 mild improvement and 10–11 no improvement. In our study, marked improvement was seen in 6 cases (30%), moderate in 12 (60%) and mild improvement in 2 cases (10%) [Table 5, Figure 2]. The comparison of before and after values of Zulewski score shows P = 0.00001.

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Figure 2:

Before and after values of Zulewski clinical score showing improvement.

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The levels of 25(OH)D₃ and TPOAb were assessed before and after homoeopathic treatment [Figures 3 and 4].

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Figure 3:

Before and after values of 25(OH)D₃ in Hashimoto thyroiditis.

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Figure 4:

Before and after values of TPOAb in Hashimoto thyroiditis.

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All the cases showed improvement in the level of 25(OH)D₃. On comparison with the initial values, 2 cases (10%) show an increase of 2.1–3 ng/mL, 15 cases (75%) show increases of 1.1–2 ng/mL and 3 cases (15%) show an increase of 0–1 ng/mL [Table 6]. The statistical analysis based on the improvement in the levels of Vitamin D before and after treatment shows P = 0.00001.

The TPOAb level was reduced in 15 cases (75%). In 5 cases (25%), despite symptomatic improvement, the TPOAb values increased slightly [Table 7]. Statistical analysis based on the reduction of TPOAb values before and after treatment shows P= 0.00208.

In the statistical analysis of the comparison of before and after values of Zulewski score, 25(OH)D₃ and TPOAb, the critical ratio, t follows a normal distribution with n–1 degree of freedom. The calculated t value is greater that tabled value at 5%, proving that the tests are statistically significant.

At the beginning of each case, the initial values of 25(OH)D₃ and TPOAb were statistically analysed using Spearman rank correlation coefficient to find the relation between 25(OH)D₃ and TPOAb level [Table 8]. The coefficient value r_s is 0.2119. P (two tailed) value is 0.03673. This shows that, in this study population of 20 cases, there was no correlation between the actual levels of Vitamin D and thyroid antibodies.

DISCUSSION

In our study, 70% of the patients were housewives from the lower socioeconomic strata who were not regularly exposed to sunlight and were prone to mental stress. Along with homoeopathic medicine, they have advised exposure to sunlight and no other supplements were given. This finding was similar to the results of Chiovato et al. who stated that people with poor socioeconomic status are more prone to hypothyroidism.^[10]

In our study, Natrum mur was the most frequently prescribed remedy. This finding is supported by Satishkumar et al.’s study, where 50% of cases were prescribed Natrum mur.^[4]

A case–control study by Tamer et al. determined a difference in Vitamin D levels between patients with HT and those without; 92% of HT patients were found to be deficient in Vitamin D, compared to 63% of the control group. They also state that Vitamin D insufficiency is prevalent in autoimmune diseases.^[11] Another study, by Kim, provided evidence of an association between low Vitamin D level and HT.^[12] These results support our finding that patients with HT have low Vitamin D levels.

CONCLUSION

In our study, patients with HT who had low Vitamin D levels showed improvement in the 25(OH)D₃ and TPOAb levels as well as symptomatic improvement after the administration of the individualised homoeopathic remedy. Ultra-diluted medicines are, therefore, effective in treating the cases of Vitamin D deficient HT.

We also found no correlation between the levels of Vitamin D and thyroid antibodies; however, the exact correlation between Vitamin D deficiency and HT requires further research.