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 ones 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 (Hashimotos thyroiditis)

Transient Thyroiditis (post-partum, silent, painful)
Transient or Permanent Iatrogenic hypothyroidism, 2 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 (Hashimotos, Chronic Lymphocytic)

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, DeQuervains) Thyroiditis
2. Silent (Painless) Thyroiditis
3. Post Partum Thyroiditis
Uncommon:
1. Riedels 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.Cant
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.GOITRE52 CASES ..16 CURED.28 RELIEVED OF SYMPTOMS8
DISCONTINUED.
2. HYPOTHYROIDISM76 CASES16 CURED..42 RELIEVED8 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.
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