ABSTRACT
Hypothyroidism (also known as underactive thyroid) is a state in which the thyroid gland does not make enough thyroid hormone. Since the main purpose of thyroid hormone is to “run the body’s metabolism”, it is understandable that people with this condition will have symptoms associated with a slow metabolism. This article provides an overview of the aetiology, diagnosis, and appropriate general & homoeopathic management of underactive thyroid.
INTRODUCTION
Underactive thyroid is a very common medical condition and statistics suggest that 1 in 50 women and 1 in 1000 men will develop symptoms of hypothyroidism. It is more common in older women and can also occur more frequently during pregnancy. Thyroid is a small butterfly-shaped gland, in the front of the neck. The function of the thyroid gland is to convert iodine found in many foods into thyroid hormones triiodothyronine (T3) and thyroxine (T4). Only the thyroid gland has cells that can absorb iodine. The thyroid takes the iodine from foods, supplements and iodized salt and combines it with the amino acid tyrosine to produce T3 and T4. T3 and T4 travel throughout the body through the bloodstream and help cells convert oxygen and calories into energy. The pituitary gland produces the Thyroid Stimulating Hormone (TSH). TSH stimulates the thyroid gland to produce more T3 and T4 hormones. If the levels of T3 and T4 thyroid hormones in the blood increase, the pituitary gland responds by reducing the production of TSH. The hypothalamus gland is located in the brain, it produces the TSH Releasing Hormone (TRH) which communicates with the pituitary gland which in turn stimulates the thyroid gland by producing and releasing TSH.
CLASSIFICATION
Hypothyroidism is often classified by association with the indicated organ dysfunction
Primary - The most common forms include Hashimoto's thyroiditis (an autoimmune disease) and radioiodine therapy for hyperthyroidism. It’s due to dysfunction of thyroid gland.
Secondary - Occurs if the pituitary gland does not create enough thyroid-stimulating hormone (TSH) to induce the thyroid gland to produce enough thyroxine and triiodothyronine. Although not every case of secondary hypothyroidism has a clear-cut cause, it is usually caused by damage to the pituitary gland, as by a tumor, radiation, or surgery. Secondary hypothyroidism accounts for less than 5%or 10% of hypothyroidism cases.
Tertiary - Results when the hypothalamus fails to produce sufficient thyrotropin-releasing hormone (TRH). TRH prompts the pituitary gland to produce thyroid-stimulating hormone (TSH). Hence may also be termed hypothalamic-pituitary-axis hypothyroidism. It accounts for less than 5% of hypothyroidism cases.
CAUSES
There are several potential diseases and conditions that can cause Hypothyroidism.
Iodine deficiency is the most common cause of hypothyroidism worldwide. In iodine-replete individuals hypothyroidism is frequently caused by Hashimoto's thyroiditis, or otherwise as a result of either an absent thyroid gland or a deficiency in stimulating hormones from the hypothalamus or pituitary.
Factors such as iodine deficiency or exposure to iodine-131 from nuclear fallout, which is absorbed by the thyroid gland like regular iodide and destroys its cells, can increase the risk.
Hypothyroidism can result from postpartum thyroiditis, a condition that affects about 5% of all women within a year of giving birth, the first phase is typically hyperthyroidism; the thyroid then either returns to normal, or a woman develops hypothyroidism. Of those women who experience hypothyroidism associated with postpartum thyroiditis, one in five will develop permanent hypothyroidism requiring lifelong treatment.
Radiation therapy – Radiation used to treat cancers of the head and neck can affect thyroid gland and may lead to hypothyroidism.
Medications – A number of medications (such as lithium which is often used for psychiatric disorders) can contribute to hypothyroidism
As a Consequence of treatment for hyperthyroidism – People who suffer from hyperthyroidism are often treated with radioactive iodine or anti-thyroid medications to reduce their thyroid function. When the function is reduced too much, hypothyroidism can result.
Stress is known to be a significant contributor to thyroid dysfunction; this can be environmental stress as well as lesser-considered homeostatic stress such as fluctuating blood sugar levels and immune problems. Adrenal insufficiency can also result in hypothyroid symptoms without affecting the thyroid itself.
CLINICAL MANIFESTATIONS
Early symptoms are Hard stools or constipation, Increased sensitivity to cold, Fatigue or feeling slowed down, Heavier menstrual periods, Joint or muscle pain, Paleness or dry skin, Sadness or depression, Thin, brittle hair or fingernails, Weakness and Weight gain. Unexpected weight gain and difficulty losing weight may be one of the first noticeable signals that struggling with hypothyroidism (a sluggish thyroid) or subclinical hypothyroidism.
Late symptoms, if left untreated: Decreased taste and smell, Hoarseness, Puffy face, hands, and feet, Slow speech, Thickening of the skin, Thinning of eyebrows
A physical examination may reveal a smaller-than-normal thyroid gland, although sometimes the gland is normal size or even enlarged (goiter). The examination may also reveal: Brittle nails, Coarse features of the face, Pale or dry skin, which may be cool to the touch, Swelling of the arms and legs, Thin and brittle hair
Uncommon clinical manifestations are Impaired memory. Impaired cognitive function (brain fog) and inattentiveness, A slow heart rate with ECG changes including low voltage signals. Diminished cardiac output and decreased contractility, Reactive (or post-prandial) hypoglycemia, Sluggish reflexes, Hair loss, Anemia caused by impaired haemoglobin synthesis (decreased EPO levels), impaired intestinal iron and folate absorption or B12 deficiency from pernicious anemia, Difficulty swallowing, Shortness of breath with a shallow and slow respiratory pattern, Increased need for sleep, Irritability and mood instability, Yellowing of the skin due to impaired conversion of beta-carotene to vitamin A (carotoderma), Impaired renal function with decreased glomerular filtration rate, Acute psychosis (myxedema madness) (a rare presentation of hypothyroidism), Decreased libido in men[18] due to impairment of testicular testosterone synthesis, Decreased sense of taste and smell (anosmia), Puffy face, hands and feet (late, less common symptoms), Gynecomastia, Deafness, Enlarged tongue.
DIAGNOSIS
The only validated test to diagnose primary hypothyroidism, is to measure thyroid-stimulating hormone (TSH) and free thyroxine (T4).[40] However, these levels can be affected by non-thyroidal illnesses.
High levels of TSH indicate that the thyroid is not producing sufficient levels of thyroid hormone (mainly as thyroxine (T4) and smaller amounts of triiodothyronine (T3)). However, measuring just TSH fails to diagnose secondary and tertiary hypothyroidism, thus leading to the following suggested blood testing if the TSH is normal and hypothyroidism is still suspected:
§ Free triiodothyronine (fT3)
§ Free thyroxine (fT4)
§ Total T3
§ Total T4
Additionally, the following measurements may be needed:
§ Free T3 from 24-hour urine catch[41]
§ Antithyroid antibodies — for evidence of autoimmune diseases that may be damaging the thyroid gland
§ Serum cholesterol — which may be elevated in hypothyroidism
§ Prolactin — as a widely available test of pituitary function
§ Testing for anemia, including ferritin
§ Basal body temperature
GENERAL MANAGEMENT
Diet –
· The thyroid gland needs an array of nutrients to function optimally. Add essential fatty acids to diet. Cold water fish such as salmon and cod as well as flaxseed, walnuts and almonds are great sources. Another option is to take a daily supplement such as fish oil. Seaweed, chlorella and algae should also be consumed frequently. They are rich in iodine and essential nutrients that maintain thyroid function balance.
· Another important thing to keep in mind when it comes to a natural diet for hypothyroidism is that there are also foods that actually slow down thyroid function. These include broccoli, Brussels sprouts, cauliflower, kale, spinach, turnips, soy, beans, and mustard greens. Also, take care to avoid overly processed food and limit dairy, sugar, artificial sweeteners, caffeine, and alcohol intake.
· Natural remedies and herbs can also be used to support optimal thyroid function. Bladder wrack (Fucus vesiculosus) is a natural source of iodine, essential for healthy thyroid function. Shilajeet-Asphaltum puniabiunum is one of India’s most prized herbs and is considered a ‘wonder drug’ by many due to its high mineral content. Makandi (Coleus forskohlii) has been studied extensively for its use in supporting thyroid function. Clinical trials have shown that forskolin (a chemical found in coleus) may help to support thyroid hormone secretion.
· Supplements of Vitamin C, E, Riboflavin, Zinc, Niacin, pyridoxine might also helps boost thyroid hormone production.
Exercise
· Aerobic exercise for 15 – 20 mins a day is excellent for maintaining good thyroid function. It may boost the metabolism thus promoting good health.
HOMOEOPATHIC MANAGEMENT:
Homoeopathy considers a disease to be the result from emotional distress and frustration, which blocks the life force energy into various different organs or glands. Homoeopathy considers thyroid problem as one such autoimmune glandular dysfunction. Homoeopathy offers better chances of a cure since the treatment is based on the person's individual constitution. Conventional treatment of thyroid dysfunction relies mainly on drugs and surgery, whereas homoeopathic treatment improves the function of the thyroid gland through natural means. Homoeopathic remedies work by stimulating the body's own healing power. Homoeopathic remedies stimulate the body to reactivate the hormone secretions, replenish and restore the thyroid tissue through the pituitary and other glands as a whole allowing the body to heal itself. Another striking thing about homoeopathy is that it has no side effects. People on multiple medications can safely take homoeopathic medicines. Homoeopathic drugs are non-habit forming and have no addictive characteristics. Homeopathic remedies stimulate the body's own immune system and offer a long lasting cure rather than giving temporary relief
Homoeopathy offers good prognosis to cases of hypothyroidism. Medicines like Calcare phos, Calcarea carb, Lapis alb, Iodium, Thyroidinum, Spongia, Lycopus, Calcarea iod etc are often found indicated in cases of hypothyroidism.
Indicated Remedies | Indications |
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Thyroidinum
| stimulate the functioning of thyroid gland. It is suitable for persons who have a puffy face and complain of weight gain. They get tired easily and want to lie down all the time. They are over-sensitive to cold and their hands and feet remain cold. Thyroidinum also addresses skin problems arising out of an underactive thyroid. |
Calcarea Carbonica | next most important medicine used very frequently in cases of hypothyroidism. Its use is highly recommended when there is excessive weight gain as a consequence of thyroid issues. Next, it is prominently recommended when there is increased sensitivity to cold. It also works well when there is marked weakness, which gets worse while walking or climbing upstairs. This medicine can also help in relieving constipation in hypothyroid patients – the peculiar feature needing it is that initially, stool is hard followed by soft stool. |
Iodum | is indicated in cases especially where there are symptoms of hyper or hypo thyroidism, according to Dr. William Boericke in the "Materia Medica and Repertory." The person needing Iodum may feel very hot, agitated, and shaky with trembling hands and heart palpitations. There may be an increased appetite, with a desire to eat all day long, resulting in obesity; however, the individual may also have an increased metabolism and not be able to gain weight. Given in controlled doses and the correct potency, Iodum may help regulate the thyroid and the pituitary gland, the source of thyroid stimulating hormones. |
Natrum Mur
| It proves effective in managing certain specific complaints linked with hypothyroidism. Firstly, it manages depression. Those needing it have marked sadness and weep often. Secondly, it is a very good medicine for dealing with hair thinning and hair fall in persons suffering from hypothyroidism. Thirdly, it can be given when there is frequent exhaustion. There is tiredness and a sleepy feeling all the time. |
Sepia Officinalis
| The patients requiring this medicine are very weak, have a pale yellow face, and extremely sensitive to cold. They feel cold even in a warm room. This medicine can help in treating menstrual complaints in patients with hypothyroidism where menses are too early and are heavy. The patient feels as if the pelvic organs will come out through the vulva, therefore always sit cross-legged. |
Graphites
| mainly recommended for those patients with hypothyroidism who are very obese and over-sensitive to cold. It can also be administered to treat persistent constipation where the stool is hard and passes with great difficulty in lumps. There is a feeling of fullness in the abdomen due to gas. Persons requiring this medicine are very depressed, sad and start crying without any reason. Skin complaints, prominently dry rough skin, can be wonderfully managed with this medicine. |
Fucus vesicelosus, | power to stimulate the thyroid and pituitary gland, helping to adjust the amount of thyroid stimulating hormones, and boost metabolic processes. helping with weight loss, reducing sluggishness and fatigue. It may alleviate headaches; muscle pain and joint discomfort, as well as overcome many other unwanted symptoms of thyroid dysfunction. |
Kali carbonicum | individuals who suffer from a slow metabolism, often seen in hypothyroidism. The remedy may relieve symptoms of coldness and chilliness, pain in the back, chronic constipation, indigestion, flatulence, belching and a sour taste in the mouth. The person needing this remedy may be aggravated in general by drinking icy-cold drinks, which may produce nausea and vomiting. |
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