Hypothyroidism And Its Management 6e1t2j

HYPOTHYROIDISM AND ITS MANAGEMENT Prof.Dr.S.Praveen Kumar H.O.D, Dept. of Medicine, JSPS GHMC, Hyderabad., Jt. Sec, Global Homoeopathic Foundation., Ass. Editor, NJH.

INTRODUCTION: Hypothyroidism is a condition in which body doesn't have sufficient thyroid hormone levels in the blood stream. Two billion people around the world have Iodine deficiency.62 million Indians have Hypothyroidism.Among them 3.47 % are not aware. 60 % of these people are women.It has been estimated that 1 TSF of Iodine is sufficient for one’s whole life ( 150 mcg/ day) Recent survey in 8 metro cities in our country showed that one person out of ten is having Hypothyroidism. KOLKATTA 21.67%, DELHI 11.07 %, HYDERABAD 8.88 % WOMEN 15.86 %, MEN 5.02 % 46 – 54 YRS. 13.11 % 18 – 35 YRS. 7.53 % These staggering figures bring us to a question….. Is excess use of iodised salt and defective diet apart from stress responsible for the increase of hypothyroidism cases in the past 13 years to the tune of 26 % ?.

Medical review:

Definition: Deficiency of thyroid hormone Causes

• •

Primary (TSH high)

~95%

Secondary (TSH low)

~5%

• •

•

Pituitary disease Hypothalamic disease

Thyroid Hormone Resistance (rare)

Relatively common:

• • •

2% adult women, 0.2% adult men >60 yrs: 6% adult women; 2% adult men May be higher in select groups

Wide Range of Hypothyroidism Asymptomatic to Severe:

•

Biochemical: Very common; TSH 6-10 IU/ml, with normal T4, T3. Treatment is controversial & should be correlated with improvement in symptoms

•

Myxedema Coma: Profound, severe hypothyroidism

Onset: Usually Gradual ± Goiter Risk Factors: Age >60, female, history of thyroid disease, history of radiotherapy to head/neck, family history of thyroid disease, lithium or amiodarone therapy. Etiologies of Primary Hypothyroidism

Loss of Functional Thyroid Tissue

• • • •

Chronic/Autoimmune thyroiditis (Hashimoto’s thyroiditis) Transient Thyroiditis (post-partum, silent, painful) Transient or Permanent Iatrogenic hypothyroidism, 2º to surgery or following thyroid ablation therapy

131

Congenital Thyroid Agenesis/Dysgenesis

Interference with T4/T3 Production 1. Drug-Induced Defects in T4 Biosynthesis  Anti-thyroid drugs, lithium, iodide, amiodarone 2. Iodine Deficiency (rare in US, common in 3rd world) 3. Congenital Defects in Thyroid Hormone Production (rare)

Clinical Features: Hypothyroidism Constitutional Symptoms: 1. Cold Intolerance 2. Fatigue, Lethargy 3. Hoarseness Integument: Thickened/yellowed, Dry, Non-pitting Edema (=“Myxedema”) of hands/feet/periorbital region, Cool,  Perspiration, Alopecia. Cardiovascular:  contractility,  rate,  cardiac output, pericardial/pleural effusions,  peripheral vascular resistance. CHF rare. Gastrointestinal:  Appetite, Constipation, Weight Gain (5-10% increase) Gynecologic: Menorrhagia, Menstrual Irregularities Musculoskeletal: Myalgias, Arthralgias Hematologic: Anemia Neurologic: 1. Delayed relaxation phase of DTRs, Difficulty Concentrating, Poor Memory, Somnolence, Depression, Headache, Paresthesia 2. Myxedema Autoimmune Thyroiditis (Hashimoto’s, Chronic Lymphocytic)

I

1. 2. 3. 4. 5.

High titers of anti-thyroid antibodies Lymphocytic Infiltration of thyroid gland, fibrosis Firm, non-tender diffuse goiter #1 cause of hypothyroidism (70%) Usually permanent

Other Types of Thyroiditis 1. Painful (Subacute, DeQuervain’s) Thyroiditis 2. Silent (Painless) Thyroiditis 3. Post Partum Thyroiditis Uncommon: 1. Riedel’s Thyroiditis 2. Acute Suppurative Thyroiditis Hypothyroidism in Pregnancy Fetal thyroid forms at ~11th week of life Maternal/Fetal placental transfer: 1. T4/T3 is limited 2. No TSH 3. Limited anti-thyroid drugs 4. TSI Antibodies can cross: may cause transient neonatal Graves’ Maternal thyroid status may be important for cognitive development during the first trimester. Maternal T4 needs may increase by 10-25% during pregnancy Hypothyroidism in Infants Delayed Growth & Development Poor Feeding Prolonged Neonatal Jaundice Umbilical Hernia Protruding Tongue Delayed Bone Age 1. Hypothyroidism in Infants 2. Hypothyroidism in Children Short Stature, Delayed Bone Age Increased Wt for Ht Age School performance often does not suffer Other symptoms/signs similar to adults Pituitary enlargement may occur Precipitating Factors: Severe Illness

1. Infection 2. Cerebrovascular Accident 3. Seizure 4. GI Hemorrhage/ Surgery/ Sedative Drugs/Anesthetics 5. Severe Hypothyroidism “Myxedema Coma” - A clinical diagnosis at the end of a hypothryoid continuum 1. 2. 3. 4. 5. 6. 7.

Bradycardia, Hypotension Hypothermia Hypoventilation Stupor, Coma Delayed deep tendon reflexes Dry, puffy skin History of thyroid surgery, T4 supplementation, or RAI

DIET IN HYPOTHYROIDISM Diet also plays a major role in the treatment. Iodine-Rich Foods For Hypothyroidism are; Iodized Salt ,Seaweeds and Seafoods ,Salt Water Fish ,Sushi ,Nori Rolls ,Celtic Sea Salt ,Shrimp,Turkey,Low fat milk,Egg,Banana Foods GOOD For Hypothyroidism Selenium-Rich,Meat ,Chicken ,Salmon ,Tuna ,Whole Unrefined Grains ,Brazil Nuts ,Dairy Products ,Garlic ,Onions ,Stimulating foods,Sea weed, Coconut, Avocado,Saturated fats (Butter,Coconut oil),Fruits,Coffee.

Cassava ,Linseed ,Kohlrabi ,Peanuts ,Kale ,Turnips ,Mustard Seeds,Cabbage Broccoli,Mustard ,Millet ,Cauliflower ,Rutabagas ,Peaches ,Coffee ,Spinach,Tapioca. Bamboo shoots ,Soybeans and related products ,Canola Oil ,Horseradish, Foods with Gluten ,Garden Kres ,Tempeh ,Babassu,Sweet Potato . Goitrogenic Chemicals: These chemicals, when ingested through processed food or medications can cause goitre:Amiodarone ,Lithium ,Oxazolidines ,Iopanoic acid ,Minocycline (MN),Propylthiouracil ,Thioureylene a,Sulfadimethoxine ,Carbamazepine Phenobarbitone

Homeopathic Approach for the treatment: There are excellent remedies in Homeopathy for the patients suffering from hypothyroidism symptoms. The homeopathic remedies are prepared from a wide range of substances such as the vegetables, herbs, minerals, chemicals and animal products in extremely minute doses. The homeopathic remedy selected will be based on all the symptoms of the patient including physical, mental and emotional states, and family history of the patient. 1. Homeopathic remedies stimulate the body's own immune system and offer a long lasting cure rather than giving temporary relief. 2. In the contemporary Allopathic method of treatment Hypothyroidism is almost a life long disorder and requires daily treatment. Where as in Homoeopathy it can be completely cured in many number of patients. 3. The treatment in this disorder is also on the same lines like other so called incurable diseases. Constitutional treatment plays a major role in the treatment along with miasmatic approach. 4. Some of the commonly indicated remedies are Calc,Iod,Calc Iod, Brom,Kali Iod, Nat Mur, Spong; Thyr, Lapis alba, Lycopus V. Let us just see how the following sample of cases were helped by Homoeopathic treatment. CASE NO.1 21 YR. Young man, software engineer having 2yrs of married life. C/O: Sev. Anxiety ,Tension, Loss of Appetite feeling SAD always, Not interested in anything.Started losing weight.No more thrill in sex.Symptoms started after wife went to her parents house for delivery.Diagnosed to have HYPOTHYROIDISM and Reports showed Hypothyroidism.He was given Thyronorm 75 mcg per day.He was reluctant to start.After Homoeo medicine his TSH came down.He is doing very good; depression came down. CASE NO.2 45Yr old man, Software engineer.Developed loss of appetite, Constipation, Fr. Attacks of cold,Erectile Dysfunction ,Early ejaculation, Lack of sleep.Domestic as well as Job tension .Takes up the responsibility and does the work to the satisfaction of every one concerned.Yet the boss puts lot of stress and as well the wife and in-laws.Can’t retaliate nor answer back; too good a person.Diagnosed to have Hypothyroidism and advised to take Eltroxin 100 mcg daily along with other drugs to correct ED.TSH level still continued to be high and the symptoms also continued unabated.Then Homoeopathic constitutional treatment corrected not only his symptoms but also TSH level.He is doing good without Eltroxin and is on our medicine . CASE NO:5 20 yr old young lady, recently married.Irregular menses since 9 months ( Engaged since)Got menses only 2 times in last 9 months.Bleeding was scanty. Started putting on weight ( 9 Kgs increased) which caused severe tension.High expectations from in-laws; insulting and ridiculing husband.Was put on routine remedies like CALC IOD

200, 0/1 and THYROIDINUM 6X which readily brought down TSH level drastically.But for the better and long lasting relief she was given constitutional treatment which made her bright, agile and normal from many angles. She was given Carc 10 m followed by Graph 0/1, 0/3 . STATISTICAL ANALYSIS

IN THE PAST 35 YEARS OF CLINICAL EXPERIENCE …… TOTAL NO. OF CASES treated -285 * MALE-52 / FEMALE-203/CHILDREN-30 * CURED-22/ RELIEVED-197 /DISCONTINUED-37/ NO RELIEF-29 1.GOITRE…52 CASES ..16 CURED….28 RELIEVED OF SYMPTOMS…8 DISCONTINUED. 2. HYPOTHYROIDISM…76 CASES…16 CURED…..42 RELIEVED…8 DISCONTINUED. INFERENCE FROM THE EXPERIENCE 1. CONSTITUTIONAL REMEDY CAN CORRECT THYROID DYSFUNCTION PERMANENTLY WITH OUT DEPENDING ON ANY DAILY TABLET. 2. IODISED SALT IN EXCESS WOULD DEFINITELY CONTRIBUTE FOR THE THYROID DYSFUNCTION HENCE SHOULD BE AVOIDED. ********************************************************************************************************