Dr Jesiah Anto Poovendan
Introduction
Hypothyroidism is second most common endocrine disorder worldwide, occurring due to deficiency in circulating thyroid hormones. Subclinical hypothyroidism(SCH) characteristically presents with normal thyroxine (T4) levels and elevated thyroid stimulating hormone (TSH) levels. According to a recent Indian study , SCH prevalence was 24.7% and showed a higher prevalence in the older population aged between 61 and 70 years(38.5%).
CASE SUMMARY
A female aged 26 presented with complaints of hair fall, tiredness, constipation, weight gain, diagnosed as subclinical hypothyroidism, based on investigation. An individualized Homoeopathic medicine IGNIS ALCOHOLIS was selected and prescribed for the patient, on the basis of totality of characteristic symptom and analysis by repertorization. TSH levels were investigated and analyzed before and after treatment. Post treatment analysis was done using Modified Naranjo Criteria for Homoeopathy (MONARCH ), which determines the causal attribution of clinical outcome after the Homoeopathic intervention. During the period of 5 months, the patients symptoms completely subsided and the TSH levels were maintained within normal limits. So this case is helpful in analyzing the effectiveness of individualized Homoeopathic medication in treating sub clinical hypothyroidism.
PRESENTING COMPLAINT
A female patient aged 26 reported to our outpatient department with complaint of hair fall in bunches
and tiredness since many years. Constipation, passes 2- 3 days once. Weight gain from 61 kg to 65 kg within 2 months. Headache since 12 std, especially in occiput extending to neck and shoulder with nausea and aggravated on, sun exposure, bright light on and off. Better on, sleeping in dark room.
PHYSICAL GENERALS
- Appetite-good, can tolerate hunger, eats thrice a day at regular intervals
- Thirst- decreased, drinks 1-2 liters , very little amount at long intervals
- Sleep- 1am-9am, unrefreshed sleep
- Stool- constipation passes stool 2-3 days once in morning
- Urine – yellow , no odour, no difficulty , passes 4 times in morning and 2 times in night
- Perspiration-scanty , no odour, no sediments
- Dreams-bats flying in sky++, rats(roaming)in ground
MENSTRUAL HISTORY
- Lmp-20/7/2023
- Regular menses, no leucorrhoea
- Dysmenorrhea on and off
- Before menses, bilateral ankle pain with swelling, better during menses
MENTAL GENERALS
- Aversion to criticism
- Aversion and gets anger being questioned when anyone interrupt her++
- Anger if anyone finds faults on her
- Image conscious
- Desire appreciation++
- Fear of insects and lizards+++
- Aversion animals++
DIAGNOSTIC ASSESSMENT AND LAB INVESTIGATION
- Rep dt- 1/7/2023
- Ft3-2.85
- Ft4-0.90
- Tsh-16.830
Based on symptomatology and correlation with laboratory reports she was diagnosed as subclinical hypothyroidism
TOTALITY OF SYMPTOMS
kentian method of evaluation was selected and totality of symptoms were constructed, as it contains , striking, prominent, mentals and physical generals.
- Dreams-bats flying in sky++,rats roaming in the ground
- Desire appreciation++
- Fear of insects and lizards+++
- Aversion animals
- Thirst- decreased, drinks very little amount at late intervals
- Constipation in morning
- Dreams-bats flying in sky++,rats roaming in the ground
- Perspiration-scanty
- Hair fall
- Tiredness
- Hypothyroidism
RUBRIC SELECTED
- Mind- animals- aversion
- Dream- bats- invading out of the sky
- Dream- rats
- Mind- fear insects of
- Glands- thyroid gland-general- hypothyroid
- Head- hair- falling-handful of
- Rectum -constipation- accompanied by-straining
- Perspiration- scanty -sweat
REPERTORIAL RESULT
- SEPIA- 5/4
- NATRUM MUR-5/3
- PHOS-5/3
- IGNIS ALCOHOLIS-3/3
THERAPEUTIC INTERVENTION
Using radar software and after repertorization, and in reference with materia medica, IGNIS ALCOHOLIS was selected as similimum for this patient , as it covered, characteristic mental generals of this patient . Patient was prescribed with IGNIS ALCOHOLIS in 30 centesimal potency once a day for 1 month.
PRESCRIPTION : IGNIS ALOHOLIS 30 c od for 4 weeks
FOLLOW UP { Patient was followed up regularly every month
| DATE | symptoms | medicine |
| 28/8/2023 |
|
Rx IGNIS ALCOHOLIS 30 OD for 4 weeks |
| 30/09/2023 |
|
Rx IGNIS ALCOHOLIS 30 OD for 4 weeks |
| 28/10/2023 |
|
Rx SAC LAC TDS for 4 weeks |
| 25/11/2023 |
|
Rx IGNIS ALCOHOLIS 30 OD for 4 weeks |
| 26/12/2023 |
|
Rx SAC LAC 30 TDS for 4 weeks |
| THE MODIFIED NARANJO CRITERIA HOMOEOPATHY(MONARCH)(10) |
|
SI.NO |
MODIFIED NARANJO CRITERIA | YES | NO | NOT SURE | CASE |
| 1. | Was there an improvement in the main symptom or condition for which the homoeopathic medicine was prescribed? | +2 | -1 | 0 | Yes
+2 |
| 2. | Did the clinical improvement occur within a plausible timeframe relative to the drug intake | +1 | -1 | 0 | Yes
+1 |
| 3. | Was there any initial aggravation of symptoms? | 0 | 0 | 0 | No
0 |
| 4 | Did the effect encompass more than the main symptom or condition (i.e. were other symptoms ultimately improved or changed)? | +1 | 0 | 0 | Yes
+1 |
| 5 | Did overall wellbeing improve? (suggest using validated scale) | +1 | 0 | 0 | Yes
+1 |
| 6 | Direction of cure: did some symptoms improve in the opposite order
of the development of symptoms of the disease? |
0 | 0 | 0 | No
0 |
| 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 downward. | +1 | 0 | 0 | Yes
+1 |
|
| 7 | Did old symptoms (defined as nonseasonal and non-cyclical that were previously thought to have resolved) reappear temporarily during the course of improvements? | 0 | 0 | 0 | Yes
0 |
| 8 | Are there alternate causes (other than the medicine) that—with a high probability—could have caused the improvement? (Consider the known course of the disease, other forms of treatment, and other clinically relevant interventions). | -3 | +1 | 0 | No
+1 |
| 9 | Was the health improvement confirmed by any objective evidence? (e.g., lab test,
clinical observation, etc.) |
+2 | 0 | 0 | Yes
+2 |
| 10 | Did repeat dosing, if conducted, create similar clinical improvement? | 0 | 0 | 0 | Yes
0 |
| Total score (Maximum score= +13; Minimum score = -3) | Total
+9 |
DISCUSSION
In this case, patient presented with complaint of hair fall, tiredness, constipation and weight gain and she was diagnosed as subclinical hypothyroid on correlation with laboratory investigation. Even though she has common symptoms of clinical condition, she had some peculiar mental generals and physical generals.
On the basis of totality of characteristic symptoms ,case analysis was done and with help of Radar software, repertorization was done .In 6th edition of organon aphorism, 154, Hahnemann states that, “ the most suitable medicine contain those peculiar, uncommon, singular and distinguishing (characteristic) symptoms, which are to be met with in the disease to be cured in the greatest number and in the greatest similarity, this medicine is the most appropriate Homoeopathic specific remedy for this morbid state”(13), which shows importance of characteristic , peculiar symptoms. Based on Hahnemannian principle,
An individualized Homoeopathic medicine IGNIS ALCOHOLIS(15) was selected as similimum for this patient.
IGNIS ALCOHOLIS(15) was a medicine prepared by burning and combustion of pure alcohol followed by potentization .Even though , it was not well proven remedy, it has peculiar dream and fear symptoms noted from provers such as dreams of fire, silver fish, bats, rats, animals, lizards, buying and selling houses, etc.This striking general symptoms, matched with peculiar generals of the patient, irrespective of particular symptoms. So this remedy was selected and prescribed in 30 centesimal potency for the patient
TSH levels were investigated and analyzed before and after treatment. TSH before treatment, was 16.830 μIU/mL and TSH after 5 months of treatment is 3.46 μIU/mL.a marked improvement of symptoms also noted after the course of treatment.
Post treatment analysis was done using The Modified Naranjo Criteria for Homoeopathy (MONARCH)10, for determining the causal attribution of clinical outcome after the Homoeopathic intervention. The total score was +9 thus suggesting the possible association between the medicine and the outcome. And this indicates positive role of individualized Homoeopathy medicine which was exact similimum for the patient. Patient had complete recovery of symptoms and restoration of her TSH levels to normal within 5 months. So, this case report was helpful in analyzing the effectiveness of individualized Homoeopathy medicine IGNIS ALCHOLIS in treating subclinical Hypothyroidism.
CONCLUSION
Hence this case report evidently suggests, effectiveness of individualized Homoeopathy medicine in treating subclinical hypothyroidism and also efficacy of rare remedy IGNIS ALCOHOLIS in this case.
This case also highlights the importance of individualization for selecting similimum and treating the patient and not disease
REFERENCES
- Ralston, S. H., Penman, I. D., Strachan, M. W. J., & Hobson, R. (Eds.). (2022). Davidson’s principles and practice of medicine(24 th ed.). Elsevier Health Sciences.
- Sandhya A Kamath, Siddharth N Shah; API textbook of medicine;12th edition; Jaypee Brothers Medical Publishers (P) Ltd published ;2022
- Samuel Hahnemann; Textbook of Organon of medicine 6th edition translated by william boericke ;B jain publishers
- Robin Murphy; Textbook of case analysis and prescribing techniques;published by Bjain publisher;2004
- Robin Murphy;Textbook of Homoeopathic Medical repertory; third revised edition;published by B Jain publishers (P) Limited;2009
- S.R.Phatak; A concise repertory of homoeopathic medicines alphabetically arranged; ;2010; ;published by B Jain publishers (P) Limited;
- Dr.Frederik Schroyens ;Repertorium homoeopathicum syntheticum ;synthesis; Edition 9.1;2021; published by B Jain publishers (P) Limited;
- Tiwari S K ; Essentials of repertorisation 5th edition ; published by B Jain publishers (P) Limited; 2015
- Clarke henry john;A dicytionary of practical clinical materia medica,New Delhi; Indian Books & Periodicals Publishers
- Lamba CD, Gupta VK, van Haselen R, Rutten L, Mahajan N, Molla AM, Singhal R. Evaluation of the Modified Naranjo Criteria for Assessing Causal Attribution of Clinical Outcome to Homeopathic Intervention as Presented in Case Reports. Homeopathy. 2020 Nov;109(4):191-197. (Epub) 2020 Mar 25. Erratum in: Homeopathy. 2020 Oct 21;: PMID: 32215892.
- Unnikrishnan AG, Menon UV. Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab. 2011 Jul;15(Suppl 2):S78-81. doi: 10.4103/2230-8210.83329. PMID: 21966658; PMCID: PMC3169866.
- Alam, Shamim. (2020). Endocrine Disorder and their homoeopathic management. International Journal of Homoeopathic Sciences. 4. 10.33545/26164485.2020.v4.i2a.147Published online.(RESEARCHGATE)
- 13. Ye An Kim, Young Joo Park; Prevalence and Risk Factors of Subclinical Thyroid Disease ; Endocrinol Metab (Seoul).Published online 2014 Mar 14(pubmed);
- Rajesh rajput,et al ; Subclinical hypothyroidism in adults: Consensus statement of Indian thyroid society ; (Thyroid Research and Practice) Thyroid Research and Practice 19(1):p 8-23, Jan–Apr 2022.
- Nuala Eising ;Ignis alcoholis ,succinum provings; The Homoeopathic book company;1998; published online. ;1998;
Dr. JESIAH ANTO POOVENDAN, M.D.(HOM)Pediatrics
Medical Director, Santham Homoeopathy Hospital And Research Centre, Chennai.
CO-AUTHOR
Dr. RADHIKA , BHMS ,D.Acu
Assistant Medical Officer
Santham Homoeopathy Hospital And Research Centre, Chennai.
Very good jop sir all the best.very use full sir.thank you