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Original Article
5 (
1
); 3-8
doi:
10.25259/JISH_33_2021

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

Department of Repertory, Sarada Krishna Homoeopathic Medical College, Kanniyakumari, Tamil Nadu, India
Corresponding author: S. Sanofer Nazeema, Department of Repertory, Sarada Krishna Homoeopathic Medical College, Kanniyakumari, Tamil Nadu, India. sanofer28@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Nazeema SS, Kumar VS. The scope of ultra-diluted medicines in cases of Vitamin D deficient Hashimoto thyroiditis. J Intgr Stand Homoeopathy 2022;5:3-8.

Abstract

Objectives:

The objectives of the study were to understand the scope of ultra-diluted medicines (homoeopathy) in treating cases of Hashimoto thyroiditis (HT) with low Vitamin D levels (determined by measuring the 25(OH) D3 levels) and assess the relationship between Vitamin D levels and HT.

Materials and Methods:

Twenty random patients presenting with symptoms of HT and deficient in Vitamin D were selected from the outpatient department of Sarada Krishna Homoeopathic Medical College and Hospital, Kulasekharam. After detailed case taking and repertorisation, remedies were prescribed. The Zulewski score was used to assess symptomatic improvement. Vitamin D and antithyroid peroxidase antibody (TPOAb) levels were recorded before and after intervention and subjected to statistical analysis.

Results:

After homoeopathic treatment, 90% of patients showed moderate to marked improvement in the Zulewski score (P = 0.00001), 85% showed improvement in 25(OH)D3 levels (P = 0.00001) and 75% showed marked reduction in TPOAb levels (P = 0.00208).

Conclusion:

In conventional treatment, levothyroxine is administered to patients with HT; moreover, as HT is an autoimmune disease, other systems are affected in the long term. We found that the individualised homoeopathic remedy is effective in treating the condition and improves the levels of 25(OH)D3 and TPOAb with no side effects. Patients with HT have low Vitamin D levels, but we found no exact correlation between the actual levels of 25(OH)D3 and TPOAb.

Keywords

25-Hydroxyvitamin D3
Antithyroid peroxidase antibody
Hashimoto thyroiditis
Vitamin D
Zulewski clinical score

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.

Declaration of patient consent

Patients who were included in the study provided written consent. The consent was taken as their acceptance for their participation in the study.

Ethical clearance

The ethical clearance (EC/231/2019) was approved on 26 September 2019. The study was conducted between October 2019 and January 2021.

Inclusion criteria

The following criteria were included in the study:

  • Female patients

  • Patients between 8 and 60 years of age

  • Patients with elevated TPOAb levels

  • Patients with low 25(OH)D3 levels.

Exclusion criteria

  • Patients with other autoimmune and complicated systemic diseases were excluded from the study.

Study design

For each patient, a detailed case was taken. After proper analysis and repertorisation using the Synthesis Repertory, an individualised homoeopathic remedy was prescribed. The cases were followed for a period of 6 months–1 year. The Zulewski score and the 25(OH)D3 and TPOAb levels were determined before and after prescription.

Statistical analysis

The comparisons of the pre-and post-intervention levels were done using paired t-test and relationship between their levels was analysed using Spearman rank of correlation. The data were entered with the help of Microsoft Excel 2019 (Microsoft Corp., Washington, US). SPSS version 24.0 (IBM Corp., Armonk, NY) was used to perform the statistical analysis.

Descriptive statistics

The mean, standard deviation, frequency and percentage were calculated. Tables, diagrams and graphs were used for data presentation.

Inferential statistics

Student’s paired t-test was used for continuous variables. The Chi-square test was used for categorical variables. One-way ANOVA was used for continuous dependent variables for the vital parameters.

Tests for normality

The Kolmogorov–Smirnov and Shapiro–Wilk tests were used to check the normality of the data. The data follow normal distribution.

Significance level

All statistical tests were considered significant if P < 0.05 was considered.

RESULTS

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

Table 1:: Distribution of cases according to the frequent symptoms.
Symptoms No. of cases Percentage
Fear 7 35
Menstrual irregularities 10 50
Heat and cold intolerance 8 40
Weakness and tiredness 14 70
Increased or reduced perspiration 10 50
Grief 9 45
Appetite diminished 8 40
Obesity 8 40
Pain in extremities 8 40
Weeping 7 35
Palpitation 7 35
Desire for cold food 4 20
Anger and irritability 5 25
Constipation 5 25
Hoarseness of voice 4 20
Leucorrhoea 3 15

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

Table 2:: Distribution of cases based on socioeconomic status.
Socioeconomic status No. of cases Percentage
Upper class 13 65
Middle class 4 20
Lower class 3 15
Table 3:: Distribution of cases based on their occupation.
Occupation No. of cases Percentage
Housewives 12 60
Students 4 20
Daily labourers 3 15
Accountant 1 5

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

Table 4:: Distribution of cases based on the age group.
Age group No. of cases Percentage
11–20 3 15
21–30 4 20
31–40 9 45
41–50 2 10
51–60 2 10

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.

Figure 1:: Distribution of cases according to the prescribed remedy.

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.

Table 5:: Improvement of cases based on the Zulewski score.
Improvement No. of cases Percentage
Marked 6 30
Moderate 12 60
Mild 2 10
No improvement 0 0
Figure 2:: Before and after values of Zulewski clinical score showing improvement.

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

Figure 3:: Before and after values of 25(OH)D3 in Hashimoto thyroiditis.
Figure 4:: Before and after values of TPOAb in Hashimoto thyroiditis.

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.

Table 6:: Improvement in the 25(OH) D3 levels in cases.
Cases Vitamin D3 (25(OH) D3) Improvement
Before After
1 23.23 25.0 1.77
2 24 24.94 0.94
3 23.7 24.8 1.10
4 18.6 20.1 1.5
5 13.3 14.5 1.2
6 22.7 24.1 1.4
7 19.6 21.8 2.2
8 12.6 14.5 1.9
9 12.75 13.8 1.05
10 25.4 26.8 1.4
11 22.7 24 1.3
12 16.54 17.3 0.76
13 17.9 19.3 1.4
14 19.3 22 2.7
15 16.3 17.9 1.6
16 18.2 19.6 1.4
17 20.1 21.4 1.3
18 15.7 16.9 1.2
19 23.4 24.5 1.1
20 19.3 19.5 0.2

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.

Table 7:: Improvement in the TPOAb level in the cases.
Cases TPOAb level Reduced/increased
Before After
1 573.10 329.0 Reduced
2 564.1 279.0 Reduced
3 40.76 51.03 Increased
4 364.7 100.5 Reduced
5 97.04 38.26 Reduced
6 >600 423.7 Reduced
7 127 35.25 Reduced
8 402.70 404 Increased
9 190.3 54.6 Reduced
10 227.3 120.70 Reduced
11 141.3 63.4 Reduced
12 126.8 130.62 Increased
13 103.4 52.0 Reduced
14 52 101.2 Increased
15 72.2 51.2 Reduced
16 696.3 237.7 Reduced
17 72.15 101.1 Increased
18 33.35 32.5 Reduced
19 368.5 76.9 Reduced
20 49.04 43.1 Reduced

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 rs 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.

Table 8:: Comparison of the initial values of 25(OH) D3 and TPOAb.
Cases (25(OH) D3) TPOAb
1 23.23 573.10
2 24 564.1
3 23.7 40.76
4 18.6 364.7
5 13.3 97.04
6 22.7 >600
7 19.6 127
8 12.6 402.70
9 12.75 190.3
10 25.4 227.3
11 22.7 141.3
12 16.54 126.8
13 17.9 103.4
14 19.3 52
15 16.3 72.2
16 18.2 696.3
17 20.1 72.15
18 15.7 33.35
19 23.4 368.5
20 19.3 49.04

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.

Limitations

  • Only 20 patients were included in this study. Larger sample size is needed to make the conclusion more valid

  • Due to COVID-19, some patients did not come out of their homes for exposure to sunlight.

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.

Acknowledgements

We extend our sincere thanks to the patients who participated in the study. We also appreciate the nursing staff and laboratory technicians for their valuable cooperation in completing the study.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. Calcium-Binding Proteins in Health and Disease Amsterdam, Netherlands: Elsevier; .
    [Google Scholar]
  2. , . Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab. 2011;15:S78.
    [CrossRef] [PubMed] [Google Scholar]
  3. Dietary Reference Intakes for Calcium and Vitamin D Washington, DC, United States: National Academies Press; .
    [Google Scholar]
  4. , , , , . Homoeopathy for anti-thyroid peroxidase antibody Titer in Hashimoto's thyroiditis-a clinical study. Ann Rom Soc Cell Biol. 2021;25:6494-501.
    [Google Scholar]
  5. , , , . Vitamin D deficiency in India. J Family Med Prim Care. 2018;7:324-30.
    [CrossRef] [PubMed] [Google Scholar]
  6. , , , , , , et al. Vitamin D deficiency and Hashimoto's thyroiditis in children and adolescents: A critical Vitamin D level for this association? J Clin Res Pediatr Endocrinol. 2015;7:128-33.
    [CrossRef] [PubMed] [Google Scholar]
  7. , , , , , , et al. Vitamin D and thyroid disease: To D or not to D? Eur J Clin Nutr. 2015;69:291-6.
    [CrossRef] [PubMed] [Google Scholar]
  8. , , , , . Estimation of tissue hypothyroidism by a new clinical score: Evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab. 1997;82:771-6.
    [CrossRef] [PubMed] [Google Scholar]
  9. . Case report on Hashimoto's thyroiditis and homoeopathy. Pain. 2019;6:25.
    [Google Scholar]
  10. , , . Hypothyroidism in context: Where we've been and where we're going. Adv Ther. 2019;36:47-58.
    [CrossRef] [PubMed] [Google Scholar]
  11. , , , . Relative Vitamin D insufficiency in Hashimoto's thyroiditis. Thyroid. 2011;21:891-6.
    [CrossRef] [PubMed] [Google Scholar]
  12. . Low Vitamin D status is associated with hypothyroid Hashimoto's thyroiditis. Hormones. 2016;15:385-93.
    [CrossRef] [PubMed] [Google Scholar]
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