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A Case Of Thyroid Disorder For Discussion

14 years old girl came with abnormal thyroid profile as follows  TSH = 0.02, T3 = 254, T4 = 13.30.

Her mother said that she (the patient) is very weak since 1 year, she had recurrent fevers and also increased  hair falling .

(G: Girl, M: Me (Doctor))

 

G: “ Doctor, Actually I was very immune  before one year, but last year it was very worse, I was affected physically” (She spoke very nervous and anxious, with a good matured tone and language)

 

M: What happened last year?

G: More troubles came doctor – I could not find what is wrong in me – I feel very sad about my health  - Some skin eruptions came last year the doctor treated as allergy . After this incidence only my health was worse. After some days my brother got same kind of erution which was diagnosed as chicken pox. (Everytime she answers with closed eyes and she was blinking always).

 

M: Tell me about you.

G: I am very short tempered at home, I will cry and  shout out my anger. Disturbing me while studying will cause more anger to me.  My brother will always interrupt me but my father will not punish him. My father will be very strict. My father will scold me more than my brother. I will feel more anger that time.

 

M: Anything more about your complaints?

G: I have sudden memory loss – will forget small works in the middle of major works. My menstrual periods are irregular.

 

M: Tell me about your LMP, and details of your Menstrual period – nature of flow, number of days and any accompanied symptoms during menses?

G:   My last date was  24.11.10, 40 or 50 days cycle with 4 days flow. Bright red flow no clots. The abdomen and back will be paining before menses. Jelly like white discharge after menses which will make me more tired and weak.

 

M: Tell me about your desires and Aversion – In food particularly / climate

G: I like Salt Very much (+++) , Cauliflower Manchurian++

M: Climate?

G: Autumn+++

M: Why?

G: because the Coldness, Leaves shed, pleasant walking Climate (Very Vivaciously  explained)

M: color you like most?

G: Baby pink color.

 

M: tell  me about your thirst, How much you drink at a time and interval of time for the next drink?

G: I usually drink more water once and will drink after long time 2-3 hours interval.

M: Tell me in which position you feel comfort in sleep?

G: Usually Lying on abdomen with right hand under my forehead and right leg folded.

 

M: Will you see any dreams in your sleep or any kind of repeated dreams?

G: usually I see mountains, beach, sea like natural scenes in my dream and some time some animals may chase me in dreams.

 

Additional Details from Mother: Menarchy – 12 years of age

The father and mother of this girl were my patients. I have treated Her father with Nuxvomica for his headache, such a dominating and nervous individual. And her mother was also a hyperthyroid individual who was treated with Lycopodium .

 

The Rubrics :  Complete Repertory – 2005:

Mind Anger, Sudden

Mind, Anger , Controlled, suppressed

Mind, excitement, excitable; general nervous

Mind, Disturbed, averse to being

Mind, Anger, Interruption from

Mind , Colors, desires, pink

Mind , Autumn, Desires

Mind , Sensitive,  Over sensitive, General, reprimands, criticism, reproaches to

Eyes, Winking

Sleep, position, abdomen on

Sleep, Position, abdomen  on, arm, arms , under head with

Female, Menses Irregular

Female, leucorrhoea, Jelly like

Female, Leucorrhoea, exhausting , weakening

Generalities, Food and Drinks, Salt or salty food desires

 

The above mentioned Rubrics value:

1. CALCAREA CARBONICUM            =   18/ 7

2. NUX VOMICA                             =   16/ 7

3. BELLADONNA                             =   15/ 5

4. COCCULUS                                 =  14 / 7

5. CHINA OFFICINALIS                    =  14 / 5

6. CAUSTICUM                               =  13 / 6

7. SULPHUR                                   =  13 / 6

8. IGNATIA AMARA                         =  12 / 6

9. NATRUM MURIATICUM                =  12 / 5

10. ARGENTUM NITRICUM               =   12 / 4

 

Analysis of the case:

I wanted to vomit certain common symptoms and  tried elimination method. Took 4 predominant symptoms for elimination

 

1.    Mind , Sensitive, Over sensitive, General, reprimands, criticism, reproaches to

Through out the case the sensitive talk of the girl and her attitude,  she was more concerned about the disturbance, his fathers scoldings.

 

2.    Eyes, Winking

A predominant objective symptom, which was representing her nervousness, fear, anxious etc. It was persistent through out the case. It is her individual symptom not relating to disease.

 

3.    Generalities, food and Drinks, Salt or Salty

This was a strong physical general in the case.

 

4.    Sleep, position, abdomen on

This was one symptom which was representing the patients’ persistent symptom since childhood. (Confirmed From Mother)

 

The remedies covering all the above four rubrics were:

1.  CALCAREA CARBONICUM, 2. CARCINOSINUM

 

for further confirmation, I asked the girl What are all her interests other than studies, She said I am interested in Drawing

I gave a paper and asked her to draw what she wishes – She made a neat drawing of a plant in a pot without any flaw.

Relating this creativity with the above remedies my choice was more towards Carcinosinum. And also her precocity speeches make me to think of the remedy. Whereas Calcarea will not show much interest in extracurricular activities they will not involve in new things.

 

Referred THE SOUL OF REMEDIES - Dr. Rajan Sankaran,

 

“Carcinosinum people often have a history of taking on too much at a young age having too many expectations placed on them, too strict parental control”

“The need for perfection males carcinosinum people sensitive to reprimands, and fastidious in every sphere of life to the point of being faultless…. Show interest towards artistic things like music , dancing and painting. They are sensitive to enjoy beautiful scenery, sea shore, Thunderstroms and lightening…. Sensitive to reprimands …”

 

After referring the Book  CARCINOSINUM was given to the Girl.

 

RX

Date: 04.01.2011

CARCINOSINUM – 30 CH – 1 PILL (#20) IN WATER

2 STROKES LEAVE 1 DROP IN 100 ML WATER, STIRR WELL AND TAKE ONE SPOON TODAY ONLY.

CALL BACK AFTER 3 DAYS

 

FOLLOW UP 1:

Date: 10.01.2011

Through phone:

After taking medicine no change for 2 days.

Menstruation started on 09.01.2011 , Feels more pain in back (usually the pain will not be such intense during menses)

Rx

Please wait till next menses and call back me

No need to take medicines

Inference: Medicine might be started working – Shall wait without interrupting

FOLLOW UP 2:

Date: 14.02.2011

Through phone:

Last month menstruation cycle completed by 14.01.2011

This month Menses started on 12.02.2011

I am not worried about my health now – feeling better

During this menses the pains were tolerable

Rx

Wait Till Next menstrual period

No need for medicine

Inference:

1.     There was general improvement in major complaint

2.    Medicine is still acting

 FOLLOW UP 3:

Date:  05.04.2011

I cannot remember small things

Leucorrhoea is more , before menses, Stains more, Light yellow-milky white jelly like discharge

Last menstrual period was on 30.03.2011 without any pain

Dreams of Cricket – India is winning the Championship.

NO Winking of eyes , Answers very casually and politely without any anxious or nervousness

Rx

Placebo – 3 doses SOS

 FOLLOW UP 4:

Date: 04.06.2011

Forgetfulness for little things still present

Hair loss have reduced now – far better than before

Has better sleep than before, refreshing too.

Leucorrhoea present – after menses/p>

Pain in left lumbo sacral region on and off – As if elastic stretching and relaxing.

Last month about 10 daysTook allopathic tablet (Antibiotics) for Sore throat

Investigation Report Dated: 18.05.2011

              T3 = 93, T4 = 6.08, TSH = 20.79

Rx

CARCINOSINUM – 30 CH – 1 PILL (#20)

200 ml water dose – 12 hours once – 1 spoon – for 3 days

Inference:

1.    Dose repetition done Since there is Forgetfulness is persisting

2.    Reason for not changing any new remedy  is Carsinosin have acted good, Thyroid profile is almost normal.

3.    TSH increased than normal –This might be Subclinical hypothyroidism. Since the patient has mild elevation in TSH doubt whether in right or wrong direction. Shall check for Thyroid profile after 1 month.

 FOLLOW UP 5:

Date: 06.06.2011

Through Phone:

Sore throat came back again.

Rx

Continue the Course of water dose for 3 days and call back after 1 month

 

FOLLOW UP 6: Date: 06.07.2011
Through Phone:
L.M.P - 16.06.2011
No specific Complaints.
Pain in the Low back, Aching pain Since 2 months.
? may be due to lifting school bag - But why it is paining for me alone Doctor? 
 
Rx 
No prescrition Made
Have asked the patient to Come on Saturday for Review.
 
Next Follow up plan:
1. Have to recheck TSH Value.2. Evalaute General Health.3. Look for appearance of any New Symptom / deeper level symptom. 
 
FOLLOW UP 7: Date: 11.07.2011
 
(D: Doctor, P: Patient)
D: Tell me, how is your health and changes you feel in these last 2 months.
P: I am Okay. There are some complaints. The back pain which I told you few days back is absent since a week.
I have got a eruption in my head, it is paining – Some discharges were coming. I feel difficult to comb my hair.
I am having White discharge per vagina – Not much like before but scanty on and off daily.
 
(O/E It was an abscess on the vertex – when the patient tried to show me that it broken , pus and blood were coming out- Cleaned the wound with a cotton and the pus were drained)
 
D: Tell me further.
P: Now a days I am getting bored up with studies.
 
D: Bored in the sense you have no interest or just want a relaxation?
P: I feel I am getting overloaded with studies, since I am 10th standard now. I have interest I am   scoring same good marks as before.
 
D: How is your memory weakness?
P: I feel it has improved 1 percent may be. But not worsened.
 
D: What else?
P: My hair falling is increased a little.
I am getting depressed suddenly now days.
 
D: Depressed means for what?
P: If someone criticized me I am getting much upset. Say for example if I have lost a game in my PET class all are starting commenting on my loss. That makes me more anger. For 2-3 times I use to control my anger or else I use to weep, then start console myself. Sometimes use to scold them. After coming home I will say everything to my mother. She will advise me.
Moreover if they start criticizing me about my personality I will get more anger and feel upset.
They will comment about the spectacle and face of mine.
Sometimes I try to play more games and more time to show them I can do it.
Previously I won’t bother  for any quarrels at school when I come home but now it bothers me.
I am getting more anger on them , Why they are behaving so?
 
D: Tell me further.
P:  I usually hate the school and like my home, But now I hate my Home.
D: Why? Since When?
P: Since my 9th Standard. They (Parents)are totally trying to change me Doctor, especially my father. They are trying to change me according to the people around and for that they are giving their own life examples and imposing such things on me and want me to do what they did.
 
D: what feel on such circumstances?
P: I feel irritated , I feel some kind of feeling inside me (The word used was “pulupulunu irukum”). Why they are behaving like this to me ? they are behaving as if they all are good and what ever I do is wrong.
And I totally don’t like Comparing me with my brother. My father use to do this all aspects and he will praise my brother that he is too good than me.
 
He (Father) won’t even show interest on my  wishes, even for buying a guide for my studies. These kinds of incidence will hurt me more. He will not encourage my positive side instead he will always pointing out my mistakes.
I like to go outings but my home wont allow me.
Such things got stagnated and suddenly outburst one day as a great anger for any matter. That time they all will see my anger alone but not my feelings.
 
The negative comments on me make me more anger. Anger is more - Bursting out of anger - When my brother touches  me.
Now days I have got used up with scolding, if someone scold me I feel to laugh at them.
 
 D: Can u draw any picture now?
P: No doctor, I am not in a mood to draw now.
 
Other Details:
Dreams : writing a test, teaching like dreams, dreams of missing bus.
Winking the eyes while answering on and off. (not like the first consultation)
Appetie: satisfied - Evening alone is abrupt
Thirst: Has increased thirst since 1 month,
Stool and urine: Normal
 
Investigation:
Dated: 11.07.2011
Serum TSH - 12.58 uIu/ml

 

Rx

CARCINOSINUM - 30 CH - 1 PILL - 100 ML WATER DOSE

2 STROKES, 1 DROP, 1 SPOON - ONCE

WAIT FOR 1 MONTH

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Comment by Charuvahan on July 3, 2011 at 1:26pm
Yes sir, thank you for your keen evaluation. I am in the same thought, has repeated the Carcinosinum once and waiting for result. Have asked the patient to take the Thyroid Profile once again. Will share the result soon
Comment by Dr. Sayed Tahir Hassan on July 3, 2011 at 9:28am

From the presenting symptoms, its sub-clinical hypothyroidism, could be part of developing Hashimoto's disease, better evaluate just to aid for further prognosis. Suppression of chicken pox or other similar lesions can cause auto-immune disorders resulting in functional disturbances before the actual disease sets in.

CARCIN is great medicine for most auto-immune disorders. Thank you for sharing.

Comment by Charuvahan on June 25, 2011 at 1:44pm
Dear Claudia, The suppression of chickenpox might have some impact in this case But i am not Sure. Thanks for sharing your view

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