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Hypothyroidism is insufficiency of thyroid hormone required for normal growth and functioning of the body.

THYROID HORMONE AND ITS PHYSIOLOGY

Thyroid Hormones are produced in body only by thyroid glands , its a butterfly shaped glands situated in neck each lobe on either side of trachea connected with isthemus on midline behind hyoid bone.

T3 or tri-iodothyronine or liothyronine and T4 or thyroxine are active thyroid hormones partially composed of Iodine, so iodine is required for production of T3 and T4.

Hypothalamus releases Thyrotropin Releasing Hormone(TRH) which stimulates Pitutary glands to secret Thyroid Stimulating Hormone(TSH) which stimulates thyroid glands to produce thyroglobulin which is precursor of thyroid hormones, the residue of thyroglobulin is protien tyrosin which undergoes iodination with help of thyroperoxidase forming thyroid hormone.(1 molecule of thyroglobulin has 100-120 residual tyrosin of which only 20 undergoes iodination with help of thyroperoxidase in follicular colloid and rusultant formation of upto 10 thyroid hormone molecule from 1 thyroglobulin molecule.)Hypothalamo-pitutary-thyroid axis regulates levels of thyroid hormone in blood, increased level of T3 and T4 inhibibits TSH and TRH. Thus regulating proper balance of blood level of thyroid hormone.

T4 is converted into T3 with help of Deiodinases , these Deiodinases are Selenium based compounds, So sufficient selenium is required for production of T3 , its then converted into T1a (iodothyronamine)and T0a (thyronamine) by decarboxylation and deiodination.

In blood almost 99.97% thyroxine is bound to Thyroxine binding globulin only free thyroxine is biologically active.

Thyroid hormones helps in protien, fat and carbohydrate metabolism and stimulates vitamin metabolism. It is essential for proper development and differentiation of cells, it influences almost each and every cell bt binding with thyroid hormone receptor on neucleus of cells and it activates gene to express cell specific protiens to neucleus of the body and on cell membrane it attaches to integrin αvβ3 stimulating sodium-hydrogen anti-porter and activating processes like cell growth and formation of blood vessels. it also helps in maturation of neurons and bone growth, it promotes catecholeamines sensitivity.

Regulation of thyroid hormone levels is influenced by many different physiological and pathological stimulus.

HYPOTHYROIDISM MAY BE CAUSED DUE TO

Defective Thyroid Gland itself , functioning inadequately, its called Primary Hypothyroidism. It is caused due to Iodine Deficiency, autoimmune Thyroiditis like Hashimato’s Thyroiditis where auto antibodies are driven against Thyroglobulin, Thyroxine peroxidase, TSH receptors which infilterate thyroid glands, post partum thyroiditis, subacute lymphocytic thyroiditis, subacute granulomatous thyroiditis, certain medications , radio-iodine procedure, thyroidectomy.
Lack of sufficient stimulus by Thyroid stimulating Hormone (TSH), which is secreted from pitutary glands, it is called Secondary Hypothyroidism.
Inadequate Thyroid Releasing Hormone(TRH), which is secreted from Hypothalamus, its called Tertiary Hypothyroidism.

A person can suffer from one or above all three types of causes of hypothyroidism.

Central Hypothyroidism, any hypothyroidism which can be classified under Secondary or Tertiary cause is termed as Central Hypothyroidism, their causes are any lesions compressing the pitutary, injury to pitutarty due to surger or other reasons , pitutary irradiation, certain drugs influencing pitutary, vascular disorders affecting pitutary, intracranial heamorrhages, certain autoimmune diseases like lymphocytic hypophysitis, certain infiltrative diseases, infection and congenital disorders.

SIGNS AND SYMPTOMS OF HYPOTHYROIDISM

Fatigue , patient gets tired easily, frequently complaints of aching sensation in limbs and very occasionaly complaints of sensation of trembling of limbs
Somnolence, sleepy feeling throughout the day and Insomnia, cant get proper sleep at night
Weakness and lethargy, pt complaints of general weakness and lack of interest to do any physical activity.
Coldness, cold feet and hands , slightly lower body temperature, cant tolerate cold climate.
Dry thick and coarse skin
Hoarseness in voice
Tendency to catch cold easily
Lack of concerntration and weak memory
Depression, lack of interest , gloomy and melancholic.
Delayed cycles with initial heavy flow and later very scanty flow.
Oedematous swelling of limbs and face
Myxedema
Hearing deteriorates
Slow Pulse Rate
Carpel Tunnel Syndrome
Delayed Tendon Relaxation Reflexes.

DIAGNOSIS OF HYPOTHYROIDISM

Blood test

T4 and TSH levels helps diagnose the condition

Low T4 and elevated TSH suggests Hypothyroidism
Low T4 and normal/low TSH suggests Hypothyroidism of central origin.
Normal T4 and elevated TSH suggests Subclinical Hypothyroidism.

T3 levels are just extra parameter and should not be considered primary parameter, according to current guidelines T4 and TSH levels are considered first and T3 is used for extra guidance.

In many cases, patient shows signs and symptoms of hypothyroidism but their FT3 FT4 and TSH levels are absolutely normal in such cases antithyroglobulin and anti TPO antibodies test should be done to rule out Hashimoto’s Thyroiditis.

HOMEOPATHIC MEDICINES FOR HYPOTHYROIDISM

Based on symptoms and condition.

THYROIDINUM

Thyroidinum is a polcrest remedy with a wide sphere of action. Thyroidinum is a sarcode prepared from dried thyroid gland of the sheep or calf. It influences all the other systems of the body. Thyroidinum is used to treat various symptoms of hypothyroidism. Hypothyroidism is usually causex due to deficiency of tbyroid hormone. Patient usually presents with general and muscular weakness, easy fatigue, mood changes, obesity, digestive disturbances. Tendency for obesity. Very good remedy for menstrual disorders like menorrhagia, metrorrhagia, amenorrhoea. Arrested mental and physical development. Fatigue, marked weakness, poor concentration.

IODIUM

Iodum is generally known as iodine, a non metallic trace element required by our body. Iodine has multiple functions in our body. Deficiency of iodine in human body leads to several symptoms. Iodum is a very useful remedy in case of thyroid disorders. Patient usually presents with dry skin, hair loss,, feeble muscles, puffed up face and swollen tbyroid glands. Mental and physical lethargy, weight gain. Severe exhaustion and fatigue. Ravenous hunger, eats well yet losses flesh all the time. Anxiety with increased palpitations. Great debility, slightest effort endures perspiration.

CALCAREA CARBONICA

Calcarea carb is usually suited to fair, fat, flabby persons who are always chilly and cannot tolerate cold air. Calcarea carb is Very well indicated in hypothyroidism. Excessive sweatinv on head is a leading symptom for its use in hypothyroidism patients. Feels overworked or exhausted. Forgetful, confused, misplaced and expresses herself wrongly. Women with hypothyroidism have too early, too profuse menses with vertigo. Recomended in obese patients. Pecularities in eating like craving for boiled egg. Desire for indigestible things. Presents with constipation, first part of stool hard followed by soft stools.

BROMIUM

Bromium is a deep acting remdy indicated in case of Hypothyroidism. Suited to people with flax hair, light blue eyes, fajr individuals. Tendency to cause induration and enlargement of glands. Patient is very anxious, apprehensive with great depression of spirits. Glandular swelling, stony hardnesd of glands. All glands are affected thyroid, parotid, submaxillary, ublingual etc. The thyroid gland may bulge at one side and may be so hard as to restrict the movement. Presents with emaciation, general weakness and perspiration. Limbs are weak and tremble with growing prostration. Presents with chronic fatigue syndrome. Another important symptom of bromium is its indication of respiratory ailments especially in asthama in sailors as they go ashore.

SELENIUM

Selenium is one of the indicated remedy in case of hypothyroidism. Presents with marked mental and physical weakness.Great fatigue from which he seems unable to recuperate from rest. Sudden weakness in hot weather. Dry hacking cough with weak feeling in chet. Weak spine as if paralysed. He is sleepless till midnight, awakens early and always at the same hour. Severe hairfall. Constipation with inactivity of rectum.

APOCYANUM CANABINUM

Apocyanum cannabinum is an efficient remedy in case of hypothyroidism. Useful in dropsies. General dropsies with or without disease. Swelling of every part of body. Presents with great weakness. Low spirited, nervous. The skin feels husky and rough. Great proatration. Presents with great oppression about epigatrium with difficult breathing. Gasping for breath. In females metrorrhagia with paroxysmal flow.

BUFO RANA

Bufo is usually suited to feeble minded children and prematurely senile people. Bufo is a deep acting antisporic remedy. Main sphere of action is on glands, skin, CNS, mind. Useful in hypothyroidism. Patient is usually sad , restless, feeble minded, idiotic childish, impatient child. Inclination to bite. Presents with marked swelling of body. In female the menses are too early and too copious with clots. Weak memory, desires solitude.

HOMEOPATHIC TREATMENT, Metabolic Disorders, Nephrology, Orthopedic

GOUT

February 6, 2013 Dr Deepan Leave a comment

Gout is metabolically mediated type of arthritis strongly associated with genetics as a major cause, to which diet and lifestyle plays a contributory factor in its pathogenesis.It is primarily caused due to disorder of purine metabolism (purine is one of the major component of our gene it forms base pairs / nucleotides with pyrimidine to give structure to our gene; also purine is present in many food that we eat esp. certain sea food and many pulses).

Its when the final product of purine metabolism i.e uric acid, starts crystallizing and forming Monosodium Urate Monohydrate then it starts depositing in joint and tissues around joint its called gout and not mere hyperuricemia can be termed as gout.

PATHOGENESIS OF GOUT

GOUT PATHOGENESIS FLOW CHART

Purine De Novo Synthesis with Salvage Pathway and GOUT

Overproduction of uric acid may be due to one or more of following factors:-

Catabolism,
Loss of purine salvage mechanism,
Defective or sluggish transportation,
Under excretion of uric acid,
Reduced elimination of uric acid due competition of metabolites for elimination,

which results into hyperuricemia triggering Gout.

Although hyperuricemia has been found to trigger gout but many having maintaining uric acid within normal limits still develop gout and many having uric acid on higher side are still not developing gout. So genetics has major role in determining at what level of serum uric acid the patient may develop Gout.

When Uric acid crystalises into monosodium urate, it then starts precipitating in joints, tendons and surrounding tissues,in small clusters of deposits called tophi. Each tophus is collection of monosodium urate crystals surrounded by a protein wall. This protein wall prevents its interaction with surrounding cells and thus prevents inflamatory response. Occasionally this walled-off tophi breaks open the protein wall and so the urate crystals comes out naked in contact with surrounding cells, which may be due to medical, surgical metabolic, physical stress or sometimes even rise in serum uric acid levels may lead to breaking of this wall, which causes acute inflamation and sets in acute arthritis within few hours.

SYMPTOMS OF GOUT

Its usually observed that small joints of extremities which are not sufficiently insulated to tolerate cold and shocks and those that are in region where circulation is affected due to gravity dependence, like great toe and ankle , small joints of feet, hands and wrist are more prone compared to other joints. Although it can affect all the joints and can present itself with different signs and symptoms but it is classically known as Podagra for the one characteristic symptom it frequently presents in most of the patients, its the intense burning and sharp excruciating pain with mild redness and swelling especially on base of great toe (at first metatarso-phalangeal joint) starting suddenly and frequently at night waking patient up from sleep.

GENES ASSOCIATED WITH HYPERURICEAMIA AND GOUT

1) Absence of gene associated with breakdown of Uric Acid.

In humans unlike other carnivorous primates(meat eater in particular) the Uricase /urate oxidase, an enzyme which breaks down uric acid to 5hydroxyisourate then to allantoin, has became non functional during evolution phase and is present only as psuedogene/junk gene so, the humans have tendency towards probability of elevated levels of uric acid due to lack of breakdown and accumulation which may trigger gout.

Uric Acid though may have beneficial effect as its a very powerful antioxidant and scavenger, helping body to protect itself from oxidative damage and thus prolonging life and reducing age-specific cancers, so hominids may have opted out the Uricase gene in selective evolution.

After we identified urate oxidase and its activity, we have artificially prepared protien Rasburicase. Rasburicase is now used to treat patient developing acute hyperuriceamia during chemotherapy. Also a PEGylated form of urate oxidase is in clinical development for treatment of chronic hyperuriceamia having “treatment failure gout”.

2) Defect in genes associated transportation and transfer of uric acid for elimination.

SLC2A9 The encoded protein by this gene plays a role in transportation of uric acid and also in development and survival of chondrocytes in the cartilage matrix. Any SNP (single neucleotide polymorphism) in this gene causes transcript variants encoding different isoforms, which increases the risk of development of Hyperuriceamia and also it may alter joint cartilage matrix both of these anomaly plays a major role in formation of gout.
SLC22A12 has 2 transcript variants encoding different isoforms; basically it encodes urate transporter and urate anion exchanger protein which regulates the level of urate in the blood; its an integral membrane protien primarily found in kidney; SNP of this gene causes altered reabsorption of Uric Acid by the kidney.

3) Genes associated with purine salvage mechanism.

PRPSAP1 and HPRT1 are gene related to Purine salvage mechanism.
Phosphoribosyl Pyrophosphate Synthatase associated Protein 1(PRPSAP1).
PRPP (5-phosphoribosyl 1- pyrophosphate) is a substrate used by HGPRT during purine salvage pathway.
Hypoxanthine Phosphoribosyl Transferase 1 (produce hypoxanthine-guanine phosphoribosyl transferase (HGRPT)which plays main role in generation of purine nucleotide through purine salvage pathway).

SNP or deletion of any of the above mentioned gene causes hyperuriceamia and also other severe conditions.

4)Certain Genetic Disease And Syndromes Presents Hyperuricemia And Gout As One Of The Symptom Like In :-

Familial Juvenile Hypouricemic Nephropathy (FJHN) associated with UMOD gene. UMOD gene produces Tamm horsfall protien, whose function is still not well understood but defect in this gene produce many autosomal renal disorders characterised by juvenile onset of hyperuricemia, gout and progressive renal failure.
Medullary Cystic Kidney disease (type I and II).
Lesch Nyham Syndrome is an X-linked Syndrome caused due to HPRT1 Gene deletion (details of HPRT1 have been mentioned elsewhere above in this page).

Physical trauma, Wasting Diseases ,Surgery are associated with increased uric acid levels.

MEDICINES ASSOCIATED WITH HYPERURICEMIA

Diuretics in higher doses, niacin, aspirin ACE inihibitors angiotensin receptor blockers beta Blockers ritonavir pyrazineamide ciclosporin tacrolimus.

DIAGNOSIS OF GOUT

In patients with recurrent acute episodes of arthritis especially of great toe accompanying hyperuricemia is sufficient to establish the diagnosis. However an episode of acute arthritis in many instances may not accompany hyperuricemia, so arthroscentesis should be done for synovial fluid analysis for visualising monosodium urate crystals or tophus is the only confirmatory test whether patient is hyperuricemic or not.

DIET AND LIFESTYLE ASSOCIATED TO GOUT AND HYPERURICEMIA

Food rich in purine especially red meat and sea food is considered to be associated with hyperuricemia. Its found that moderate consumption of purine rich vegetarian diet is not associated with the condition. Also total protien has no impact untill not much of it is in form of purine.

Alcohol consumption and Fructose sweetened food and drinks are strongly associated with it.

Metabolic syndrome, diabetes, cardiovascular disease, and aging process are also associated with this condition and they tend to worsen each other.

Vitamin C, Coffee and switching to Dairy Products for protein requirement will also help.

Weight reduction and regular exercise helps reduce Uric acid.

Raised uric acid level is also associated with renal stones and urate nephropathy.

HOMOEOPATHIC REMEDIES FOR GOUT and HYPERURICEMIA(raised serum uric acid)

ARNICA MONTANA

Arnica is a traumatic remedy par excellence. Arnica is an useful remedy in chronic cases of gout. Old cases of gout rouse into a new soreness of joints with great sensitiveness. Arnica is an important remedy in injuries, bruises, shocks etc. Trauma in all its varieties mental or physical and their effects recent or remote are met with this remedy. If we observe a arnica patient in order to get the external manifestations of his state, he is constantly moving,turning and highly restless. The patient has sore lame bruised feeling, so sore that he can lie on one part only for a while and must keep changing position as the bed he lies on feels hard. Limbs ache as if beaten. Inflamation of joints.

ACTEA RACEMOSA

Actea racemosa is a very well indicated remedy in gouty and rheumatic diathesis. Swelling of joints with raised uric acid levels. Its muscular and crampy pains are primarily neurotic origin, occuring in nearly every part of the body. Pains of actea racemosa are like that of electric shock, comes suddenly and also its relieved suddenly. There is stiffness and pain in the tendo achillies. It has wide action on muscles nerves joints. Rheumatic aching pains in joints and muscles with stifness of joints. Causes depression of mind with low spirits and exhaustion along with oversensitiveness especially during pain.

ABROTANUM

Abrotanum is a very valuable remedy which is used more frequently. Indicated in gout and increased uric acid levels. Rheumatism and gout alternate with haemorrhoids. Abrotanum increases circulation and opens small arteries as a result the blood flow and local defense of joints and muscles is stimulated. Abrotanum relives gout pain.

ACONITE NAPELLUS

Aconite napellus is very well indicated in rheumatic and gouty conditions of joints. Those that come on as first attack. Not old rheumatic and gouty attacks but those that come on from exposure to cold. Rapidity of action of aconite determines its symptomatology. Presents with Symptoms are acute painful and violent pain in the joints. Aconite is indicated in acute onset of pain and swelling. Used in 1st stage of inflammatory condition with severe mental restlessness. Fear. Fright and anxiety.

BELLADONNA

Belladona is useful in inflamtory rheumatism and gout.Symptoms that suggest this remedy are sudden onset, swollen joints, red hot, throbbing pain with extreme sensitiveness. Complaints of belladona that is the pains and suffering come on suddenly run a regular course and subside suddenly. Sudden attack of cold worsens the complaints.

COLCHICUM AUTUMNALE

Colchicum is a primary remedy used for treatment of gout because of its effectiveness.most useful in chronic gout.
Colchicum has marked action of the joints, indicated in case of gouty arthritis and increased uric acid levels. Helps in relieving the gouty paroxysms. Inflammation of great toe, gout in heel, cannot bear to be touched. Oedematous swelling and coldness of feet. Joints are red hot swollen. Pains are usually worse in evening and night.

LEDUM PALUSTURE

Ledum pal is mostly used in rheumatic and gouty diathesis. Remedy affects the fibrous tissues of joints especially small joints, ankles,heels.Used in cases where the gouty pains shoot through the foot, limbs and smaller joints. There is great swelling in the foot and ankle. Joints hot and swollen with with cracking in joints. Gouty nodosities. Ball of great toe is swollen. Soles are very painful can hardly step on them. Aggravation from warmth is so vreat that the patient can only get relief to his rheumatism by sitting with his feet in icy cold water.

NATRUM SULPHURICUM

Natrum sulph is used for symptoms associated with gout it may be acute or chronic. Swelling and burning of joints. Pain compels frequent change in position with stiffness of joints. Burning in sole with oedema of feet.

RHUS TOXICODENDRON

Rhus tox is one of the most frequently indicated remedy for rheumatic and gouty complaints. Rhus tox usually affects the fibrous tissue markedly joints, tendons, producing pain and stiffness. Rhus plays a good role in gouty complaints. Hot painful swelling of joints. Tearning pains in tendons, ligaments and fasciae. Affects the smaller joints, parts feel sore and bruised with stiffmess. All complaints worse from cold damp weather and motion in any ailment and relieved from warmth.

URTICA URENS

Urtica is useful in rheumatic and gouty diathesis. This remedy helps in elimination of uric acid from the body. The patient has tendency to uric acid and gout formation. The joint complaints are usually associated with hive like erruptions. Presents with pain in small joints. Worse from exposure to cold moist air, wet weather.

BENZOICUM ACIDUM

Benzoicum Acidim is a very Specific and Infallible remedy in cases of chronic and acute gout, usually given in lower potencies in frequent repetitions.

Dr SHAH's Homeopathy