A Case Of Primary Hypothyroidism

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A CASE OF PRIMARY HYPOTHYROIDISM

A Diffusely Enlarged Thyroid

Initial Visit: April 5, 1988

A 30-year-old woman, recently a mother (seven months ago), presented with the complaint of hypothyroidism. In March, her thyroid values were as follows: T4 = 1.0 (normal range is 4.5-13.0) and TSH = 50 (normal range is 0.4-6.0).

She complained of the following:

No energy (3) for 2 1/2 months, worse in the morning on waking (2) and from 5 to 9 p.m. (1).

Roughness in the throat (1).

Goiter.

Poor appetite, without weight loss.

Soreness of muscles in the shoulders (trapezia; worse reaching up), back, and legs (1).

For the past three months, her extremities have often fallen asleep; the arm and hand on the side lain on would go numb; the leg crossed over the other becomes numb.

Tired (sleepy) but on lying down at night to sleep she becomes anxious and wakeful; feels restless (3) and wiggles her legs (2). She then feels that she should be doing something, should go somewhere (2). She is anxious and restless when lying down during the day (2). Her legs are also restless when sitting (2).

There is much inertia to overcome before she can start working at home (2). She has a mellow temperament; not easily upset; no fears. Often feels she should be doing something; likes to be active. She is sympathetic (1), confident, assertive, and social. She used to be anxious before tests (2).

Sexual sphere is normal.

Desires ice cream (3) (all her life) and sweets (2) (more recently).

Averse to spicy food (2).

Was very thirsty; now is thirstless (2).

Appetite is normal.

She is exhausted for one hour after waking in the morning and is averse to getting out of bed then (3).

Averse to excess heat (1). Is all right in the sun. She always has very cold hands and feet (3), and is worse in cold air. Sensitive to cold drafts (1). Little perspiration.

Dry skin, mostly on the hands (2), with some cracking of the skin on the fingertips (1). Her nails flake and chip (1).

After having had no dental cavities in the preceding 10 years, she recently had several cavities.

Some dizziness when she is tired and in the early evening.

Physical Examination: The patient is moderately obese and fair-skinned. The exam was unremarkable except for a diffusely enlarged, firm thyroid.

Guess: That's the case as it originally presented itself. Do you have any suggestions for remedies?

Sheryl Kipnis: I have an idea. I was struck by two symptoms in the case. One is the great fatigue and the other is the restlessness. They seem contradictory. The other symptom that stood out for me was the difficulty she is having with her nails and her teeth, which seems to be associated with the hypothyroid problem. This makes me think about Calcarea carbonica, calcium metabolism. The sluggishness makes me think about a Calcarea remedy, but the restlessness, the goiter, and the enlargement of the glands make me think about Iodium. This raises the possibility of Calcarea iodata, but I have no experience with the remedy. Boericke does mention thyroid enlargement and cracking of the skin for Calcarea iodata. The patient noticed both of these symptoms.

Guess: That's a great idea. Anybody else?

Audience: I guess I will suggest the obvious. There are some confirmatories for Zincum metallicum, but I don't know that much about the remedy in this context. The repertory lists it under "swelling of the external throat," although it is not under "goiter." This remedy obviously has the restlessness, the cracking of the skin, the teeth falling out, and the energy worse in the evening. So I'll suggest Zincum metallicum.

Jeff Baker: I agree with Dr. Kipnis. I think the case has a look of Calcarea, but I'm thinking of Calcarea sulphurica. It seems to run through the case fairly well. The anxiety while lying is a relatively small rubric but is quite characteristic of the case. Calcarea sulphurica is one of only nine remedies listed in that rubric. I think the remedy should be there, actually. Also, the remedy is worse in cold drafts. The food cravings have both a Calcarea and a Sulphur took to them. In the repertory, Calcarea sulphurica is a goiter remedy in italics.

Guess: Thanks. That's another great thought.

Audience: I have a thought too, which is also along the Calcarea line. But I would recommend Rhus toxicodendron, because here is a woman who is very fatigued and is very restless. She feels that she has to be doing something all the time. The main symptom for me in this case is the restlessness while lying down and the restlessness in the legs. She is also worse from cold air and drafts. If you look at the case you think, "Maybe this woman is Calcarea carbonica." But Rhus toxicodendron seems to cover this case. Maybe she needs Rhus toxicodendron now and Calcarea carbonica later.

Guess: The remedy that cured her is often confused with Rhus toxicodendron. But, initially, I did not prescribe the correct remedy. I first gave her Calcarea carbonica, with no effect. Let's look at a more detailed analysis of the case.

Case Analysis and Differential Discussion

I chose the following symptoms for repertorization:

SLEEP: Unrefreshing
MIND: Restlessness, evening, bed in
MIND: Anxiety, evening, bed in
MIND: Restlessness, lying, while
SLEEP: Sleeplessness, evening, bed, after going to
STOMACH: Desires, sweets
STOMACH: Desires, ice cream
STOMACH: Thirstless
EXTREMITIES: Restlessness, sitting, while
MIND: Indolence
TEETH: Caries, decayed, hollow
EXTREMITIES: Dryness, hands
EXTREMITIES: Cracked skin, hands
EXTERNAL THROAT: Goiter

It is apparent from the results of the repertorization that the following remedies merit our consideration: Calcarea carbonica, Lycopodium, Phosphorus, Ammonium carbonicum, Magnesia carbonica, and Magnesia muriatica. Which of these seems to best fit this case?

Calcarea carbonica is certainly a major goiter remedy, and its overall symptom profile closely mimics the hypothyroid state. In this case, many of the patient's symptoms are shared with Calcarea carbonica: indolence, lethargy, desire for ice cream and sweets, cold hands and feet, soreness from exertion, obesity, dental caries, anxiety in the evening in bed, dry and cracked skin of the hands, and rough throat. There are no absolute contraindications for Calcarea carbonica, except for its failure to cover the strongest and most peculiar aspects of this case.

Lycopodium repertorizes quite well, as you will note, and it figures prominently in the repertory for anxiety and restlessness in the evening in bed; the pretest anxiety also matches Lycopodium. Certain confirmatory symptoms are present: desiring sweets and feeling unrefreshed in the morning. The aggravation between 5 and 9 p.m. is only minimal in this case and, consequently, not a confirmation. We lack the characteristic gastrointestinal symptoms, sleeping on the right side, and other symptoms. But, most importantly, as with Calcarea carbonica, Lycopodium does not best cover the most striking symptoms of this case.

Phosphorus is contraindicated by the strong thirstlessness, and, other than the strong desire for ice cream, there are no confirming symptoms for this remedy.

Ammonium carbonicum has an image that is not consistent with this case. It is more appropriate for heart or lung (and menstrual) pathology. We don't have the characteristic dyspnea or obstructed respiration in sleep, the aggravation at 3 a.m., the acrid discharges, and other such symptoms.

Magnesia carbonica is a thought, but not a good one. It is a goiter remedy. On repertorization, it covers some of the case, especially the unrefreshing sleep, as is characteristic of the Magnesias. However, there is one symptom in this case that flies in the face of Magnesia carbonica: the anxiety that arises on lying down in bed at night. According to George Vithoulkas and J.H. Clarke, the anxiety and foreboding that something will happen evaporates upon going to bed in the Magnesia carbonica patient. Further, in this case, the image of Magnesia carbonica is lacking: the weak, debilitated state with anxiety and liver disturbance or neuralgias, or menstrual complaints.

Finally, we come to Magnesia muriatica. The most striking aspect of this case is the anxiety, restlessness, and sleeplessness that arise immediately on lying down in the evening to go to sleep. This symptom cannot be explained by hypothyroidism. This symptom, as you know, is a grand keynote of Magnesia muriatica. In addition, some of the other symptoms of the case are covered by Magnesia muriatica, as a glance at a materia medica will reveal: desire for sweets, indolence, dental caries, rough throat, and, more importantly, unrefreshed sleep -- a keynote of this remedy. The fact that it is not a "goiter remedy" must be ignored, although, as you will see, I initially failed on that count. We might also extrapolate from the presence of Magnesia carbonica in the goiter rubric that other Magnesias might also be useful for this pathology.

Certainly, there is not a lot of similarity between this case and the classic description of the symptomatology of Magnesia muriatica. But the common symptoms do share similarity to a degree: worse from the cold; repugnance to exertion; dry, rough throat; pain as from a bruise in the small of the back; numbness of the arms; drawing in the shoulder joint; heaviness and aching of the legs; uneasiness and tension of the thighs; and unrefreshing sleep -- tired in the morning (Clarke).

The case becomes strikingly similar, however, when we read Kent's description of one aspect of this remedy:

Restlessness, fidgetiness throughout the body, coupled with anxiety. This comes on at any time, but it is worse at night in bed and still worse on closing the eyes to go to sleep. When he closes the eyes, he becomes so anxious, restless and fidgety that he must throw the covers off, take a long breath or do something. He is kept awake at night by the anxious feeling.

Of course, Magnesia muriatica is best known as a remedy for impaired digestion and liver dysfunction; however, as Vithoulkas has noted, it may be appropriate for any condition when anxiety and restlessness on lying in bed (and closing the eyes) figure prominently.

The theme of duty and of feeling overloaded with tasks and responsibilities, which Vithoulkas has identified as being characteristic of Magnesia muriatica, is touched upon in this case. Note her comment that when she feels restless and anxious on lying down at night, she "feels...that she should be doing something, should go somewhere." Also, she comments that in general she often feels she should be doing something. Compare this with Vithoulkas' statements:

They are anxious to accomplish goals or fulfill promises. They become anxious if they cannot accomplish these goals, so anxious that they cannot sleep. Their frustrated sense of duty (and their sensitivity to others, with regard to injustices perpetrated) causes them to become restless and fidgety. In fact, one of the possible causations of the Magnesia muriatica pathology is their inability to accomplish tasks. As a result of their fitful sleep (and especially when the liver is dysfunctional) they awaken in the morning feeling totally unrefreshed.

Plan: The above considerations, conducted at leisure after the patient's visit, did not adequately impose themselves upon my mind during the interview. Consequently, Calcarea carbonica 10M was prescribed.

Results of the Calcarea Carbonica Prescription

May 11, 1988

T4 = 0.7

The patient was very tired (3). No other changes in symptomatology.

Assessment: There was no apparent action from Calcarea carbonica, and her T4 is even lower. Another remedy is required.

Plan: After further study, Magnesia muriatica 200c was prescribed.

Results of the Magnesia Muriatica Prescription

June 23, 1988

Feels "okay."

Energy is still low, perhaps slightly better.

Still feels tight in the throat in the morning; raspy voice in the morning; a bad taste in the mouth then too (2). "Lump in the throat (3)." Dysphagia in the morning (2) due to a tight, dry sensation.

Anxious restlessness at night is much better; there is also no restlessness now on lying down during the day, as there had been before.

No muscle soreness.

Slight tendency for extremities to go to sleep.

Wakens in the morning feeling generally okay, unless a rough day before.

Less leg restlessness when sitting.

Energy is low between 1 and 4 p.m. (2).

Not chilly, but doesn't feel the heat of this hot summer.

Low thirst (2).

Desires sweets (1), salty, ice cream (2), and breads (1).

Averse to spicy (2).

Hair to spicy (2).

Hair falls out. Dry scalp.

Nails and hands are better.

Moderate appetite. Has lost weight, approximately seven or eight pounds.

Assessment: Now we can see definite signs of positive change. Most notably, the morning energy is markedly better, muscle soreness is gone, overall energy is slightly improved, and there is a significant weight loss. Especially noteworthy now is the absence of nocturnal restlessness. Although there are persisting throat complaints and a continuing low energy, I would be loathe to represcribe Magnesia muriatica now that the keynote of nocturnal restlessness on lying down is gone.

The next remedy is not clear. I considered remedies with throat constriction from goiter, such as Calcarea sulphurica, Lycopodium, Spongia, and Crotalus cascavella.

Plan: Measure T4. The result, T4 = 4.0, suggests that the wisest course is no remedy at this time!

The Magnesia Muriatica is Repeated

July 25, 1988

Her weight continues to slowly decrease.

Throat has been raspy and dry (2) for the past four days; before then, she suffered no throat symptoms at all.

Energy is a little better; it is worse on rainy days (2). Afternoon slump is not as bad.

For the past two weeks has been having trouble falling asleep (2) due to anxiety; is not restless. This is worse on the days she is tired. Some nightmares. Trouble waking in the morning (2).

Less sensitive to cold. No cold, numb limbs. Less dryness of hair. Nails and hands are better. Some hair loss.

Clumsy with hands (1).

Thirst is slightly increased.

Desires sweets (1), bread and cereals (2), and ice cream (2).

Averse to spicy foods.

Assessment: She is still better since the original prescription of Magnesia muriatica. Interestingly, the throat symptoms subsided without another remedy. The slow pace of recovery and the return of Magnesia muriatica symptoms, namely the morning aggravation and anxious wakefulness at night, suggest the appropriateness of repeating Magnesia muriatica.

Plan: Magnesia muriatica 200c.

Continued Improvement and the Remedy Image Changes

August 29, 1988

Her energy is better.

For the past week and a half she has been wide awake the minute she hits the bed, experiencing many thoughts at that time about what she has to do the next day (3). Not restless. Also awakens about every hour (2). Sleeps on her back. Tired in the afternoon (2:30 to 3 p.m.) (1). Okay on waking now.

Sore, bruised angle of right jaw for two weeks; worse when opening the mouth (2).

Slightly dry throat.

No restless legs.

No hand clumsiness.

Weight continues to fall, for a total loss of 14 pounds.

Sex is okay.

Wandering thoughts when concentrating (2). Some trouble choosing words (1) (had this in the past).

Temperature is okay; averse heat of sun (2) now.

Voice and swallowing are okay.

Hair and scalp are better.

Desires sweets (3), breads and cereals (2), and ice cream (2).

Thirst is low (1). Wants colder drinks now.

Physical Examination: T4 = 3.8.

Assessment: Her energy is better, she is better on waking, her throat is better, and there is increasing initial sleeplessness, which is not quite similar to the previous condition. Anther change is an increased desire for sweets. My impression is that Magnesia muriatica has exerted a partial action, not being the exact simillimum at this time, and that a new remedy image is developing but is not yet apparent.

Plan: No remedy now.

Another Remedy is Needed

October 3, 1988

"I feel that I have different symptoms at different times."

Her scalp and skin are dry again (1).

On rainy days she wakens with a rough and swollen feeling in the throat and a deep, raspy voice (3); this improves later in the day. Constriction in the throat (1). Dysphagia in the morning with anything, solid or liquid (2).

Soreness of muscles lingers after any bump or straining (2).

Energy is fairly good. But it plummets during cold, wet weather (3).

Overall, not so chilly now. Cold hands and feet (2); worse from drafts (1). Little perspiration (3), even with exertion.

Concentration seems better; fades less easily. Better at choosing words.

Anxiety for loved ones (1).

Difficulty falling asleep due to mental alertness (2); no longer restless. Dreams of disasters (fire, losing people, broken relationships) (2). Sleeps on her abdomen or right side; she actually prefers the left, but suffers soreness of the left shoulder when lying on that side. Sleeps covered up.

Desires sweets (2), breads (2), ice cream (3), and milk (1).

Thirstless (2).

Gums are red and swollen.

Menses are only now recurring (she is weaning her baby). They come every five weeks.

No hand clumsiness.

Jaw is okay.

Analysis for the Next Prescription

Here is a clear change of remedy image. She is now clearly worse from cold and wet in general; she has a local aggravation of throat symptoms (hoarse in the morning and in wet weather); and she experiences soreness after straining her muscles.

I chose the following symptoms for repertorization:

GENERALITIES: Wet weather
GENERALITIES: Cold, aggravated, wet weather
STOMACH: Desires, ice cream
STOMACH: Desires, sweets
STOMACH: Desires, bread
STOMACH: Thirstless
SLEEP: Sleeplessness, thoughts, from
FEVER: Perspiration, absent
LARYNX: Voice, hoarseness, wet weather aggravates
LARYNX: Voice, hoarseness, morning
LARYNX: Voice, rough
LARYNX: Voice and Speech, aggravated, wet weather
LARYNX: Voice and Speech, aggravated, air, damp
THROAT: Pain, sore throat, damp weather
THROAT: Roughness, wet weather
EXTERNAL THROAT: Goiter
EXTERNAL THROAT: Goiter, constriction
Admittedly, this is a lot of symptoms to repertorize; nonetheless, let's see what comes up. It should be no surprise.

So, Calcarea carbonica again comes up strongly, and this time the symptomatology much more clearly indicates it. Arsenicum album, Pulsatilla, Ammonium carbonicum, Sulphur, Silicea, and others bear little or no similarity to the case. Lycopodium has similarities but cannot compare to Calcarea. This patient sleeps on the right side, avoiding the left side because of the shoulder pain. Lycopodium is just the opposite: sleeps on the right side, and the shoulder pain is better lying on the painful side. The thirstlessness of the patient tends to exclude Phosphorus.

Plan: Calcarea carbonica 200c (Quinn).

Results of the Second Calcarea Carbonica Prescription

December 15, 1989

Feels less energetic (not underlined).

Frequent waking during the night (2); goes back to sleep easily; falls asleep easily now. No disaster dreams. Some trouble waking in the morning (1).

Flatulence after eating; also after drinking, even water (2). No bloating.

Is now okay during cold, wet weather. Cold feet (1).

Throat has been much better in the mornings; also has noted no difficulty with it during rainy weather.

No strained feeling in muscles. Side she lies on at night feels numb (3).

Energy is okay until early afternoon (2); better from a nap. Very weary by 4 p.m. (2); irritable and desires sweets (2) then. Is better by 9 p.m.

Scant perspiration (3).

Word choice is better; concentration is better.

No clumsiness of hands.

No taste for wine now. Desires sweets (3) and breads (2).

Low thirst.

Physical Examination:

- Her thyroid is still diffusely enlarged, mild.

- Weight = 147 lbs (a total weight loss of 14 pounds).

- Lab: T4 = 6.1!

Assessment: Despite her current complaint of lower energy (delivered with little emphasis), it is obvious that the remedy has had a salutary effect. Essentially, all symptoms are better, and the T4 has taken a big jump for the better. Of special interest is that when the Calcarea carbonica 10M (Quinn) was initially given, it did not act. It took Magnesia muriatica first, to remove a layer (improving thyroid function in the process) and to further clarify the Calcarea layer underneath. This experience should dispel the assertion of some homeopaths that the "constitutional remedy" is the only remedy that is ever required in a patient.

Plan: Wait

The Calcarea Carbonica is Repeated

March 13, 1989

She has noted again that rainy days make her mopey; she must force herself to be active (2).

Can concentrate better when reading, although she is sleepy when reading (3).

Energy is good in general; some slump in the early afternoon.

Is exercising.

Right arm goes to sleep at night (3), regardless of position. Prefers to sleep on left side (2). Sleep is generally good.

Cold feet at night (3); dry.

Normal perspiration.

Cold hands (1). Dry hands (2) for the past week on the sides of the fingers and the tips.

Normal temperature sensitivity.

Photophobia to the sunlight (3).

Early morning is her best time of day!

Desires farinaceous (2), sweets (1), cheese (2)and milk (1).

Thirsty for fruit juices.

Menses are more regular.

Physical Examination:

- Weight up to 152 lbs.

- Lab: T4 = 5.5.

Assessment: While she is still better than before taking the Calcarea carbonica, there are signs of slipping: weight is up, energy is down (during interim, had noted more energy in general), T4 is down, and the sensitivity to rainy weather has returned. Some symptoms have shifted: craving for sweets is less, perspiration is more normal, thirst is up, and sleeps on the left side (was able to return to this preferred position when her shoulder was no longer too sore). But there is no major shift in the symptom pattern. It is appropriate therefore to represcribe the remedy, although one couldn't be faulted for opting to wait.

Plan: Calcarea carbonica 200c (Quinn)

Steady Improvement: Lab Values Begin to Normalize

May 2, 1989

Felt great until her daughter was bitten by a dog; since then, she has felt anxious, experiencing recurring images of her daughter's bitten face; also anxious at night; self-reproach.

Energy is good; a little slow to start on rainy days.

Arm is not numb now.

No cold feet.

Hands are less dry.

Desires farinaceous (3).

Thirsty (2).

Assessment: The patient is better.

Plan: Wait.

June 1989

Lab: T4 = 6.2.

September 19, 1989

Generally feels quite well.

On one rainy day, she had low energy.

Phlegm in throat for one week.

Desires sweets and farinaceous.

Thirsty.

Appetite is high in the morning.

Sleep is quite good.

Eyes are slightly sensitive to light.

Skin texture is normal.

Lab:

- T4 = 10.7.

- TSH = 10.7 (down from 50).

Assessment: Her thyroid is functioning at upper levels of normal; the TSH will normalize. The continued sensitivity to wet weather and persistent food cravings suggest that Calcarea carbonica will continue to be her remedy if she relapses. (There have been hints that Lycopodium may at some time surface as well.)

Now, she remains essentially well.

Guess: Before I make some general comments on the treatment of hypothyroidism, do you have any questions?

Audience: Had there been any thyroid supplementation in this case?

Guess: No. Fortunately she was treated early.

Audience: Often postpartum women will have a certain degree of hypothyroidism and then will feel better after they wean. I was wondering how you felt her weaning fit into this change.

Guess: It may have given her a final boost, but the graph clearly demonstrates a correlation between improvement in the T4 values and the remedies given. I checked the medical literature, and I couldn't find a clear association between a transient profound hypothyroidism and the postnatal period. There is an entity called subclinical thyroiditis, in which a transient hypothyroidism follows a period of preliminary hyperthyroidism. I did question this patient about her pregnancy but couldn't elicit any hint of a symptom of hyperthyroidism.

Murray Feldman: I was wondering if you saw any etiological factors other than the postpartum?

Guess: No.

Murray Feldman: What about the domestic situation? Was there anything there?

Guess: No. The home life was normal.

Teresa Salvadore: Whitmont, in his book Psyche and Substance, has a nice comparative study between Magnesia muriatica and Calcarea carbonica. He says that both remedies are strongly focused on the theme of responsibility and can become quite anxious about it. But Calcarea carbonica goes easily into a state of exhaustion, while Magnesia muriatica goes more easily into a state of restlessness. This case makes me wonder if the two remedies could be complementary.

Guess: Well, that may be new information we can develop, and this case might give further credence to Whitmont's ideas.

Vithoulkas, in his materia medica on Magnesia muriatica, talks about the confusion between Magnesia muriatica and Rhus toxicodendron, because of that nocturnal restlessness. But Magnesia muriatica can be aggravated by milk, where we know that Rhus toxicodendron has a strong craving for it. He suggests that the milk be used as a possible differential point, although it wouldn't have helped in this case.

Comments on Treating Hypothyroid Patients Who Are on Thyroid Supplementation

In the case I just described, the patient was not taking any conventional thyroid supplementation. However, because many patients are on thyroid supplementation when they come to see us, a few comments on this situation may be of interest.

Patients can respond to homeopathic remedies while on thyroid supplementation (such as Synthroid). For example, a congenital hypothyroid case will respond to each homeopathic dose with a decrease in TSH and an improvement in symptoms, with each dose generating a progressively longer effect. Thus, it is possible not only to produce positive symptomatic changes but also to actually have a beneficial effect on the thyroid condition itself.

Patients on thyroid supplements definitely will respond to remedies given for other, nonthyroid conditions. One such patient, who came in for arthritis, allergies, and other problems, was diagnosed years ago as having hypothyroidism and has been on Synthroid ever since.

While these overlaid conditions do respond, my impression is that the extent of clinical improvement in these patients is less than optimal. I feel that, at some point in the course of treatment, the need to address the hypothyroid state with homeopathic remedies arises; however, if the patient continues on thyroid supplementation, the clinical indications for deeper treatment never surface, leaving the practitioner capable of providing only more superficial, palliative treatment. If the patient can be convinced to abandon his Synthroid, greater gains are possible, but not always assured (especially after decades of thyroid suppression).

Other practitioners I polled felt that patients on thyroid supplementation relapse earlier, in general being more clinically labile; that they are in general more difficult to treat; and that the longer they have been on thyroid supplementation, the harder they are to treat and the more difficult it is to wean them off the supplements.

Different practitioners have different methods for managing these cases. One prefers to discontinue the thyroid supplementation, prescribe a placebo, re-evaluate the case in six weeks, and then prescribe the indicated homeopathic remedy. Another physician leaves his patients on the thyroid and immediately initiates homeopathic treatment, reducing the thyroid supplementation once the patients show a response. The success of this method obviously is dependent upon the accuracy of the symptom image available at the initial interview. If no clear image is apparent, it is preferable to discontinue the thyroid supplement for four to six weeks, then re-evaluate the case.

It is generally agreed that a thyroid supplement can be discontinued for about one month before the symptoms of hypothyroidism definitely begin to reassert themselves; during that month there is little danger to the patient. Obviously the extent to which the patient's thyroid function is compromised will deter mine how wise it is to extend the period of abstinence from supplementation while awaiting a curative response to homeopathic treatment.

As you know, many patients have been incorrectly placed on thyroid supplements in the past and, after an initial adjustment period subsequent to its withdrawal, will do quite well without. The principal danger of withdrawal from thyroid supplementation is, of course, the precipitation of myxedema coma (usually occurring after some significant stress, such as an acute febrile condition). Additionally, in children, withdrawal from thyroid supplements may compromise physical growth, physical maturation, and mental development.

Guess: Do other people have observations on treating patients on thyroid supplementation, or on hypothyroid patients in general?

Michael Carlston: I've treated quite a few cases. Many of these have been what I call "factitious" hypothyroidism, because the patients were not truly hypothyroid but were put on thyroid supplementation as a stimulant to their general energy. In these and in the true cases of hypothyroidism I have never seen any problem with treating people who are on thyroid supplementation. Most of them have been able to stop the thyroid medication or certainly reduce it quite a bit.

Guess: I would like to emphasize one point regarding children with hypothyroidism. A number of these cases may stem from a congenital absence of a thyroid gland. I had a pediatric case that was not responding, but the parents did not want the child on thyroid medication. I realized at some point that he had never had a scan. I ordered one, and, in fact, the child had no thyroid. So, it's important to have a proper medical evaluation, especially in pediatric age groups. They certainly won't respond if they don't have a gland.

Jonathan Shore: One warning. Many years ago I had a patient who was hypothyroid and was on thyroid medication. I gave her Lachesis, which acted very nicely. She didn't return for follow-up because of financial constraints. About two or three months later she ended up in the emergency room in hyperthyroid crisis because I had neglected to tell her to stop her thyroid medication as her health improved.

Guess: A word to the wise.

Teresa Salvadore: I had a similar experience with Lachesis. The patient had been on thyroid medication for many years, and it was necessary to stop the medication after the remedy was given. She was having heart palpitations from the excess thyroid. The other case I wanted to bring up was a case of Hashimoto's thyroidiris that had been medicated for a year. The patient went into Hashimoto's one week after the death of her father. This turned out to be a Causticum case, and, after I gave her the Causticum, she immediately developed an intense sore throat and swollen glands that would go right to left, left to right, right to left, and so on. We waited one week, as long as she could handle it. I finally gave her Lac caninum, and her energy immediately increased more than it had ever been on the thyroid medication. We eventually weaned her off the thyroid medication, and she is doing fine. One last note. When her alternating sore throats did go away she got a rash in the shape of a butterfly on the outside of her throat, over the thyroid area. I thought this was a nice healing reaction.

Guess: A beautiful case.

International Foundation For Homeopathy.

~~~~~~~~

By George Guess

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