Dr Jishnu M, Dr Bharath Raj C K
ABSTRACT
It is a common thyroid disorder where there is nodular enlargement of the thyroid gland. This can occur with normal thyroid function. Treatment in conventional medicine varies from observation to surgical intervention depending on the severity. Homoeopathy also offers a holistic individualized therapeutic approach.
This is a case report of a 47-year-old male patient with complaints of bilateral neck swelling for 23 years. He also experienced palpitation on exertion, increased perspiration, evening weakness, pain radiating from neck to ear on movement. His thyroid function tests were within normal limits. Ultrasonography showed thyroid nodules bilaterally. FNAC confirmed benign adenomatous hyperplasia. On the basis of totality of symptoms such as desire for company, decreased appetite, increased sleep, desire for coffee, cold perspiration over head, slow and progressive onset of swelling on right side, Calcarea carb was prescribed in 200 potency. Significant improvement was observed in subjective complaints. Objective improvement was also seen in terms of reduction in neck circumference from 44 cm to 38 cm. This is a case report that shows individualized homoeopathic constitutional treatment is effective in managing euthyroid multinodular goitre.
HISTORY OF CHIEF COMPLAINT
The patient has been apparently healthy since childhood until 23 years ago when he started gradually developing a small swelling on the right side of his neck. This swelling has been slowly increasing over time and has also started involving the left side. Thus, it is now present bilaterally. The patient is now complaining of a swelling in his neck. He is also complaining of palpitation while climbing stairs. This is accompanied by increased perspiration, mainly over the head. This perspiration is of cold nature. In addition to this, the patient is also complaining of general body weakness. This is more pronounced in the evening. He is also complaining of pain in the neck while turning. This pain is radiating to the ear. There is no history of tenderness, redness, and increase in temperature over the swelling. Also, there is no history of any kind of compressive symptoms like difficulty in swallowing, breathing, and hoarseness of voice. In addition to this, there is no history of any kind of treatment being given to this swelling. Thus, this swelling has been growing slowly over the last 23 years.
DIAGNOSIS :
The diagnosis of the case was made based on the history, symptomatology and physical examination. In addition, the Thyroid function test, and USG revealed that it was a case of Euthyroid multinodular goitre
ANALYSIS OF THE CASE
To develop the complete list of symptoms, detailed case-taking has been done for analysis and evaluation. The following mental general, physical general, and characteristic symptoms have been taken into consideration for repertorisation.
REPERTORIAL TOTALITY:
The following rubrics were selected from the Synthesis repertory for case analysis.
- MIND – COMPANY – desire for -amel. in company
- HEAD – PERSPIRATION of scalp – cold
- EXTERNAL THROAT – SWELLING -Thyroid gland
- STOMACH – APPETITE – diminished
- CHEST – PALPITATION of heart -ascending stairs agg.
- SLEEP – SLEEPLESSNESS
- GENERALS – FOOD and DRINKS – coffee -desire
- GENERALS – WEAKNESS – evening
RESULT
The patient demonstrated considerable improvement with individualized homoeopathic treatment. There has been considerable reduction in the size of the thyroid enlargement, as reflected by the reduction in neck circumference from 44 cm before treatment to 38 cm at the end of the follow-up period. The patient has also demonstrated considerable relief in symptoms like weakness, palpitations on exertion, and pain in the neck radiating to the ear. The general condition has also improved, with better energy levels and sleep. The improvement has been gradual, consistent, and steady without any additional treatment. The thyroid functions have remained normal, and no new symptoms have manifested.
CONCOMITANT CARE
In addition to the homoeopathic medicine (calcarea carb), the patient has been advised dietary changes such as the regular consumption of iodine-rich foods like iodized salt and dairy products. However, the patient has been cautioned against the overconsumption of iodine. In addition, the patient has been asked to consume antioxidant-rich foods such as fruits and vegetables like spinach and whole grains. In contrast, the patient has been asked to consume goitrogenic foods such as cabbage and cauliflower in small quantities and in raw form.
| DATE | EVENT |
| 02/07/2024 | First consultation, diagnosis made treatment started |
| 30/07/2024 | Patient reported improvement, weakness reduced , neck pain improved, sleep better, gastric fullness and burning present, neck circumference reduced to 41 cm |
| 30/08/2024 | All previous complaints improved , general condition better, neck circumference reduced to 40.5 cm |
| 29/11/2024 | Further improvement observed , marked relief in symptoms , neck circumference reduced to 38.5 cm |
DISCUSSION
This paper aims to discuss a homoeopathic clinical case of euthyroid multinodular goiter. The case was managed using classical homoeopathic principles of individualization, totality of symptoms, and constitutional treatment. In particular, besides the local manifestation of the disease, such as swelling of the thyroid gland, attention was paid to the patient’s mental generals and personal characteristics.
The patient complained of a desire to be with people, to be among people, and to enjoy the company of people. She also reported a decrease in appetite, excessive sleep, a desire to drink coffee, an increase in cold sweating on the head, weakness, especially in the evening, and palpitations when climbing stairs. Of the local symptoms, slight pain was noted in the right side of the neck, where the goiter was initially localized. Later, the swelling extended to the left side. Considering the patient’s personal characteristics and the peculiarities of the course of the disease, the homoeopathic individualization was performed.
According to the repertory, the most frequent indications were made for Calcarea carbonica. This simillimum was also confirmed by the comparison of the materia medica. Thus, out of 8 possible indicators, Phosphorus, Natrum muriaticum, Arsenicum album, and Calcarea carbonica received the maximum score of 14, but the choice fell on the first remedy. In particular, the homoeopathic treatment of euthyroid multinodular goiter was started with a single dose of Calcarea carbonica 200C.
The conducted follow-up visits showed that the homoeopathic treatment had a positive effect on the patient’s condition. In particular, weakness, discomfort in the neck, palpitations, and sleep were improved. Moreover, as the treatment progressed, a decrease in the size of the thyroid gland was also noted. The circumference of the neck was measured four times: initially, it was 44 cm, then 41, 40.5, and 38.5 cm.
Thus, the clinical case of euthyroid multinodular goiter illustrates the successful use of individualized homoeopathic treatment. The selection of the indicated preparation was made on the basis of the patient’s individual characteristics and the full picture of the disease. At the same time, although the course of treatment was positive and there were no aggravations, this does not mean that homoeopathy influenced the course of the disease, given the absence of a control group. Therefore, to confirm the hypothesis, it is necessary to conduct further studies in a similar design.
CONCLUSION
This case demonstrates the effectiveness of individualized homoeopathic medicine in the management of Euthyroid multinodular goiter. This is clearly seen with the prescription of the totality of symptoms, including mental and physical generals. This has shown significant improvement in the circumference of the neck and has increased the overall well-being of the patient. This has shown sustained improvement over follow-ups and the potential of constitutional homoeopathic remedies in modifying the course of the disease. This case also demonstrates the importance of miasmatic understanding and follow-ups in the management of the case and the achievement of a favorable outcome.
PATIENT PERSPECTIVE
The patient was satisfied with the treatment, as he experienced a decrease in the swelling in his neck. He experienced an improvement in his associated symptoms like weakness, palpitations on exertion, and neck pain. This made his life better. He also experienced better sleep and an overall sense of well-being. He was relieved to see the improvement in his condition without undergoing surgery. He was comfortable with the treatment approach. He was satisfied with the holistic approach to his condition.
INFORMED CONSENT : Informed consent was obtained from the patient for publication of this case report.
REFRENCE
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Dr Jishnu M, Dr. Bharath Raj C K
Undergraduate Scholar, Professor and Guide, Department of Human Anatomy,
Alva’s Homoeopathic Medical College and Hospital, Moodbidri, Karnataka, India.
Email : jishnuss03@gmail.com
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