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Case of Subclinical Hyperthyroidism


Homeopathic Journal :: Volume: 5, Issue: 4, Feb 2012 (Regulars)   -   from Homeorizon.com
Author : Dr. R. K. Manchanda, MD (HOM), MBA (Health Care), Deputy Director (Homoeopathy), Directorate of ISM & Homoeopathy, Government of NCT of Delhi
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Article Updated: Feb 29, 2012


by Dr. R. K. Manchanda, Dr. Archana Narang*, Dr. Saurav Arora, Dr. Latika Nagpal

ABSTRACT

A female aged 32 reported in OPD at INMAS with the complaints of tremor hands, weakness, fatigue, bodyache and dyspnoea on exertion for the past one and half years. Her complaints started and progresed gradually. She had history of two spontaneous abortions and has three viable pregnancies. On GPE her pulse rate is found to be 104 bpm, B.P. 120/90 mm Hg with moderate pallor. On systemic examination her thyroid gland is grade I, firm diffuse, proximal muscle weakness is +, peri orbital swelling +, all other systems were within normal limits. Her TSH was low with normal FT4 & Tc Uptake scan was found to be 5.6 %. She was diagnosed as case of Subclinical Hyperthyroidism and was prescribed Nat mur 30 after consulting repertory and materia medica. The patient was followed up at INMAS for more then 03 months. Her two consecutive TSH reports came to be within normal limits.

  • Reference No. : 5481
  • Age : 32
  • Sex : Female
  • Occupation : Housewife
  • Religion :Hindu
  • Marital Status : Married
  • Date of Case Taking : 10th November 2008

PRESENTING COMPLAINTS

  • Tremors hands since 1-1/2 years.
  • Body ache with weakness since 4-5 months
  • Dyspnoea and palpitations since 02 months

HISTORY OF PRESENTING COMPLAINTS

Patient was apparently well 1-1/2 years back when she complained of

  1. Tremors hands
    • Mode of onset : Gradual
    • Location : Both hands
    • Sensation : Trembling
    • Modalities :
      • Aggravation : Exertion
      • Amelioration : Rest
    • Associated complaints: "Ghabrahat", pain and swelling in eyes especially after exertion.
  2. Body ache since 04-05 months
    • Mode of onset : Gradual
    • Location : Whole body
    • Sensation : Dull aching pain
      • Aggravation : N. S.
      • Amelioration : N. S.
  3. Dyspnoea since 02 months
    • Mode of onset : Gradual
    • Sensation : Breathlessness
      • Aggravation : Exertion, while eating
      • Amelioration : Drinking water
    • Associated complaints : Palpitations

PAST HISTORY: NAD

FAMILY HISTORY: NAD

PERSONAL HISTORY

  • Married since : 19 years
  • Developmental land marks : On time
  • Addictions : Nil
  • Habits : N. S.

OBS HISTORY

G5P3A2L3, history of two spontaneous abortions at two and third months respectively, all deliveries were FTNVD.

GYNAE HISTORY:

  • Menarche : 17 years of age
  • Cycle : 28 days
  • Duration : 04 days
  • Associated complaint(s) : Complaining of white discharge per vaginum since 6-7 months, especially between periods, irritating discharge

PHYSICAL GENERALS

  • Thermal reaction : Towards hot.
  • Appetite : Increased.
  • Thirst : WNL
  • Desires : Salt (2+), Sour (1+)
  • Aversion : Sweet (2+)
  • Sleep : Non- refreshing, easily disturbed
  • Dreams : Not specific
  • Perspiration : WNL
  • Urine : No associated complaints.
  • Stool : No associated complaints.

MENTAL GENERALS

  • Angered easily, cannot tolerate or control it, beats kids
  • Reserved.
  • Husband alcoholic, suppression of emotions, remains tensed because of it.

GENERAL PHYSICAL EXAMINATION

  • Built : Mesomorphic
  • Nutrition : Average
  • Decubitus : Sitting
  • Pallor : Moderate
  • Icterus : Absent
  • Cyanosis : Absent
  • Pigmentation : WNL
  • Clubbing : Absent
  • Oedema : Absent
  • Pulse : 104 /minute, good volume
  • Temperature : Afebrile
  • B.P : 120 /90 mmHg
  • Tongue : Clean and moist

SYSTEMATIC EXAMINATION

ON EXAMINATION

  • Thyroid gland : Grade I, Firm diffuse gland
  • Fine tremors both hands ++
  • No sign of exopthalmos, lid lag and retraction. Peri-orbital swelling (+).
  • Proximal muscle weakness (+).

RESPIRATORY SYSTEM EXAMINATION : NAD

CARDIVASCULAR SYSTEM EXAMINATION : S1, S2-Normal, PR-104/min, good volume

ABDOMINAL EXAMINATION : NAD

CENTRAL NERVOUS SYSTEMS EXAMINATION : NAD

JOINT EXAMINATION : NAD

CLINICAL DIAGNOSIS : Sub clinical Hyperthyroidism

 

INVESTIGATIONS DONE

All investigations were done at INMAS

  • FT3: 4.18 (WNL)
  • FT4: 13.88 (WNL)
  • TSH: 0.01 (Normal range 0.17-5.2 µIU/ml)
  • Tc Scan Uptake: 5.6 % (both lobes after 20 mins) (normal limit upto 03 %)

HOMEOPATHIC TREATMENT

Natrum mur 30/ OD/ for a month

Sac lac 30 TDS for a month

BASIS OF PRESCRIPTION

  • General make up
    • Thermal towards hot.
    • Desires Salt(2+), Sour (1+)
    • Aversion Sweet (2+)
    • Increased appetite
    • Sleep: Non- refreshing, easily disturbed
  • Particulars
    • Trembling of hands
    • Irritating leucorrhoea
    • Delayed menarche
  • Mental make up
    • Easily angered, cannot tolerate or control it, beats kids when angry
    • Reserved in nature.
    • Suppression of emotions remains tensed because of alcoholic nature of husband.

FOLLOW UPs

22.12.08

  • General condition: stable
  • Breathlessness: better
  • Tremors hand: better
  • Leucorrhoea: better
  • PR: 78/min
  • BP: 110/80 mm Hg.
  • TSH: 0.29 (WNL)
  • Prescription: Natrum mur 30 OD for a month, Sac lac 30 TDS for a month

02.02.09

  • General condition: better
  • Breathlessness: absent
  • Tremors hand: absent
  • Leucorrhoea: absent
  • PR: 74/min, fair volume, regular
  • BP: 114/82 mm Hg.
  • FT4: 14.03 pM/L (WNL)
  • TSH: 1.30 (WNL)
  • Prescription: Natrum mur 30 OD for a month, Sac lac 30 TDS for a month

COMMENTS:

The patient is Euthyroid clinically and biochemically at present.


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complaints,history.investigations and remedies are well explained.
  Comment by: Dr.paul murugan, India.    on Jun 26, 2014 0 Agree  |  0 Disagree       Report Abuse

very reasonable conclusion about the disease.and treatment with Natrum mur.--no effect and cystic degeneration of the thyroid gland is also possible..another medicine to be selected.
  Comment by: Dr.paul murugan, India.    on Apr 30, 2014 0 Agree  |  0 Disagree       Report Abuse

i like this notes
  Comment by: dr.ajay kumar, India.    on Jun 02, 2012 0 Agree  |  0 Disagree       Report Abuse

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