Thyrotoxicosis during pregnancy

Dr. Yashasvi shakdvipiya1, Dr. Noopur kumari2
Abstract:- Thyrotoxicosis during pregnancy is a very common problem now a days. The other systems of treatment may have the danger of maternal as well as foetal complications.  Homoeopathic treatment is based on the symptom similarity and finding out the individuality of the patient. It treats the patient as a whole.  This article is an attempt to depict the symptoms of thyrotoxicosis of pregnancy with the help of synthesis repertory. 

Keywords: Thyrotoxicosis, pregnancy, synthesis repertory version 9.0, TSH, HCG. 

Abbreviations: Gestational transient thyrotoxicosis (GTT), human chorionic gonadotropin (HCG), thyroid stimulating hormone (TSH), TSH receptor antibodies (TRAb).

Introduction:
Thyrotoxicosis describes a constellation of clinical features arising from elevated circulating level of thyroid hormone1. Hyperthyroidism occurs in about 2 per 1000 pregnancies.2The most common cause of thyrotoxicosis in pregnancy is gestational transient thyrotoxicosis (GTT), which occurs from the stimulatory action of human chorionic gonadotropin (HCG) on the TSH receptor.3 The other causes are grave’s disease, multinodular goiter and autonomously functioning thyroid nodules (toxic adenoma), hyperemesis gravidarum and trophoblastic disease.  1,2,3

The most common symptoms are weight loss with a normal or increased appetite, heat intolerance, palpitations, tremors and irritability. 1, 3 Clinical diagnosis is done by measuring free T4 (FT4-high), free T4 index (FT41- index), FT3 (high), and TSH (suppressed), TSH receptor antibodies (TRAb), serum HCG levels. 2, 3 Free T4 (FT4-high), free T4 index (FT41- index) has lack of standardization and has variability of results also.  Recommended TSH ranges are 0.1–2.5 mIU/L, 0.2–3.0 mIU/L, and 0.3–3.0 mIU/L for the first, second, and third trimesters, respectively. Measurement of serum TSH receptor antibodies (TRAb) is important for both diagnostic and prognostic reasons. The presence of antibodies, when evaluated concurrently with clinical findings, can help differentiate Graves’ disease from GTT. Biochemical evidence of hyperthyroidism can be seen with serum HCG levels of 100,000–500,000 IU/L, and clinical hyperthyroidism can result when levels greater than 500,000 IU/L are measured. HCG plays an important role in the maintenance of the placenta. Severely elevated serum HCG levels are observed in gestational trophoblastic disease and usually are the first clue to suggest a molar pregnancy upon initial presentation. 3 

Rubrics related to thyrotoxicosis of pregnancy as reflected in synthesis repertory4 :

  • MIND – ANXIETY – pregnancy, in- acon. Ant-t. bar-c. con. ign. kali-br. psor. stann.
  • MIND – IRRITABILITY – pregnancy, during- Cham. Sep.
  • EXTERNAL THROAT – GOITRE – pregnancy; during- Hydr.
  • CHEST – PALPITATION of heart – pregnancy, during- Arg-met. Con. Laur. LIL-T. NAT-M. SEP. sulph.
  • GENERALS – HEAT – flushes of – pregnancy, during- glon. Sulph. Verat.
  • GENERALS – CONVULSIONS – pregnancy; during- Acon. aeth. aml-ns. arn. ars. Bell. bry. calc. castm. caust. Cedr. Cham. chin. Chlol. Cic. Cina cocc. coff. CON. Cupr. ferr. Gels. glon. hell. Hydr-ac. Hyos. IGN. Ip. kali-br. kreos. lach. lyc. lyss. mag-c. mag-m. merc-c. merc-d. mill. mosch. nat-m. nux-m. Nux-v. Oena. op. phos. pilo. pitu. plat. puls. Rhus-t. sec. sep. sol-ni. spirae. Stann. staph. stram. sul-ac. sulph. valer. Verat-v. verat. zinc.
  • GENERALS – FOOD and DRINKS – food – aversion – pregnancy; during- ant-t. Laur. Nat-m. Sep.
  • GENERALS – WEAKNESS – pregnancy, in- alet. alum. alumn. calc-p. Helon. murx. Sulph. Verat.
  • GENERALS – EMACIATION – appetite with emaciation; ravenous- Abrot. acet-ac. ars-i. bac. bar-c. bar-i. brom. calc-f. CALC. chin. cina con. gaert. hydrog. IOD. ip. Kali-i. kola luf-op. Lyc. NAT-M. PETR. Phos. psor. sanic. sec. sel. sil. sul-i. Sulph. thyr. tub-r. Tub. uran-met. uran-n.

Discussion and Conclusion:
Thyrotoxicosis of pregnancy, if left untreated, can be associated with increased risks of adverse maternal, fetal, and neonatal complications. The clinical presentation, serum thyroid function test results, and serum TRAb titers can help differentiate the etiology of thyrotoxicosis. Above mentioned rubrics are few rubrics for thyrotoxicosis of pregnancy. These can be therapeutically helpful for the physician in finding out the similimum. 

References: 

  1. Colledge NR, Walker BR, Ralston SH, editors. Davidson’s Principles & Practice of Medicine. Limited , 2010: Elsevier
  2. Konar H. D.C Duttas textbook of obstetrics including perinatology and contraception. Kolkata, India: New Central Book Agency; 2011.
  3. Labadzhyan A, Brent GA, Hershman JM, Leung AM. Thyrotoxicosis of Pregnancy [Internet]. Journal of clinical & translational endocrinology. U.S. National Library of Medicine; 2014 [cited 2019May29]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166486/#R6
  4. Schroyens F. Synthesis. London: Homeopathic Book Publishers; 1993.

Dr. Yashasvi shakdvipiya1, Dr. Noopur kumari2
Asst.Prof.1
MD(Hom.)(PGR) 2
Dept. of Repertory
Dr.M.P.K.Homoeopathic Medical College, Hospital & Research Centre
Homoeopathy University, Jaipur-302029

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