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A CASE ON SUBCLINICAL

HYPERTHYROIDISM

Dr. Archana Narang, Dr. Saurav Arora,


Dr. Latika Nagpal
THYROID CLINIC, SHMC & H
Shmc.thyroidclinic@gmail.com
INTRODUCTION

Subclinical Hyperthyroidism

- Characterized by the presence of low or


undetectable plasma TSH concentration
and normal circulating free thyroid
hormones

 “Also referred to as mild/early


hyperthyroidism”
INTRODUCTION
 Usually patient is asymtomatic but
may present with some symptoms
such as palpitations, nervousness or
weight loss
 The severity is assessed by subnormal
or undetectable TSH, FT3, FT4 values,
presence of goiter and high uptake
thryoid scans (I131, Tc scan)
SHORT/LONG-TERM
EFFECTS
 Alteration in cardiac morphology and
function
Cross-sectional studies demonstrating:
 Increased heart rate
 Increased LV mass
 Enhanced LV function
 Impaired diastolic filling
Increased risk of atrial fibrillation and
stroke in older patients
ADVERSE EFFECTS
 Alteration in bone metabolism
Postmenopausal women with subclinical
hyperthyroidism have increased bone
loss
 Neuropsychological effects
Reduced quality of life
Anxiety, depression
Increased risk of dementia, Alzheimer’s
disease
WHY TO TREAT?

POTENTIAL BENEFITS OF TREATING


SUBCLINICAL HYPERTHYROIDISM
 Because its ethically and rationally
right to reduce patient’s suffering
 To check the progression of disease
further
 To cure wherever possible
 To prevent atrial fibrillation and
osteoporosis
A CASE OF SUBCLINICAL
HYPERTHYROIDISM
 A female aged 32 reported at OPD, INMAS
with the complaints of
Tremors
Weakness
Fatigue
Bodyache and dyspnoea on exertion for the
past one and half years.

Her complaints started and progresed gradually


A CASE OF SUBCLINICAL
HYPERTHYROIDISM
• OBS HISTORY:
– G5P3A2L3, history of two spontaneous abortions
at two and third months respectively, all
deliveries were FTNVD

• GYNAE HISTORY:
– Menarche : 17 years of age
– Cycle/Duration : 28 days/ 04 days
– Associated complaints : Complaining of white
discharge per Vaginum since 6-7 months,
especially between periods, irritating discharge
A CASE OF SUBCLINICAL
HYPERTHYROIDISM
THERMAL REACTION TOWARDS HOT,CANNOT
TOLERATE SUN

APPETITE INCREASED

DESIRES SALT (2+), SOUR (1+),COLD FOOD


AND DRINKS

INTOLERANCE FATTY, FRIED FOOD

AVERSION SWEET (2+)

PERSPIRATION PROFUSE, MORE ON FOREHEAD

SLEEP NON- REFRESHING, EASILY


DISTURBED
A CASE OF SUBCLINICAL
HYPERTHYROIDISM
MENTAL GENERALS
 Angered easily but never expresses her
feelings
 Reserved
 Husband alcoholic, suppression of
emotions, remains tensed because of it
GENERAL PHYSICAL
EXAMINATION
 Built : Mesomorphic
 Nutrition : Average
 Pallor : Moderate
 Pulse : 104 /minute, fair
volume, regular
 Temperature : Afebrile
 B.P : 120 /90 mmHg
 Tongue : Clean and moist
No sign of oedema, cyanosis, icterus,
clubbing
A CASE OF SUBCLINICAL
HYPERTHYROIDISM
 Thyroid gland – grade-I firm diffuse

Systemic examination revealed


Proximal muscle weakness is +
Peri orbital swelling +

All other systems were within normal


limits
A CASE OF SUBCLINICAL
HYPERTHYROIDISM
BIOCHEMICAL ANALYSIS
 TSH - 0.01 µIU/ml (low) (Normal range -
0.17-5.32 µIU/ml)
 Normal FT3, FT4
 Tecnitium Uptake scan - 5.6% (normal limit
upto 03%)

Subclinical /Mild Hyperthyroidism


HOMOEOPATHIC TREATMENT
HOMOEOPATHIC
APPROACH
 Prescribed Natrum muriaticum 30 (TDS)
after repertorizing and consulting materia
medica
 Patient followed up at INMAS every 03
weeks to 01 month for more then 03
months during which her two consecutive
TSH reports came to be within normal
limits
The patient was then put off
medication and is on observation
NATRUM MURIATICUM

MENTAL MAKE UP:


Angered
PARTICULARS
easily but never
expresses
Trembling her feelings
of hands
GENERAL
Reserved
Irritating in MAKE
leucorrhoeanature UP
DelayedThermal towards hot.
menarche
Suppression
Desires Salt(2+),of emotions,
Sour (1+) remains
tensed because of alcoholic
nature of husband
NATRUM MURIATICUM FOR THIS CASE
 GENERAL MAKE UP
Thermal towards hot.
Desires Salt(2+), Sour (1+)
Aversion Sweet (2+)
Increased appetite
Sleep: Non- refreshing, easily disturbed
 PARTICULARS
Trembling of hands
Irritating leucorrhoea
Delayed menarche
NATRUM MURIATICUM FOR THIS CASE

 Mental make up:


Angered easily but never expresses her
feelings
Reserved in nature
Suppression of emotions, remains tensed
because of alcoholic nature of husband
MANAGEMENT
 Patient is advised to
Take non Iodized salt
Take iron rich food like green leafy
vegetables, jaggery, black gram, etc
Light, non spicy, nutritious food
Maintain local hygiene
Plenty of water intake
FOLLOW UPS

 The case is being on regular follow up


at INMAS
 03 months follow up following case
taking with two TSH repeat reports
has been presented here
 The important features of the follows
ups are…….
FOLLOW UPS
 Symptomatic/Signs relief:
Breathlessness relieved gradually and is
absent now
Tremors hands absent
Irratitng discharge per vaginum absent
now
Pulse rate in range of 70-80/bpm.
Pain and swelling in eyes after exertion:
absent.
FOLLOW UPS
 Biochemical evidence:
19.12.08: TSH: 0.29 µIU/ml (WNL)
02.02.09: FT4: 14.03 pM/L
02.02.09: TSH: 1.3 µIU/ml (WNL)
FINAL COMMENTS
The patient is Euthyroid clinically and
biochemically at present and is
regular OPD at INMAS
CONCLUSION
IT IS A CONDITION WHICH AFFECTS THE
PATIENT:-
PHYSICALLY
MENTALLY
INTELLECTUALLY
SOCIALLY
&
FINANCIALLY
IF NOT TREATED IN TIME
CONCLUSION
 As patients affected by subclinical
hyperthyroidism may have symptoms it can
lead to impaired quality of life
 Cardiac morphology and function are
affected in these patients by increased heart
rate, LV mass, enhanced LV function and
impaired diastolic filling
 Untreated subclinical hyperthyroidism may
have untoward effects in young and middle-
aged therefore early treatment with indicated
Homoeopathic medicines is recommended
REFERENCES
 Biondi, B., Palmieri, E.A., Fazio, S., et al. Endogenous Subclinical
Hyperthyroidism Affects Quality of Life and Cardiac Morphology and
Function in Young and Middle-Aged Patients. Journal of Clinical
Endocrinology and Metabolism, 2000; 85(12):4701-4705.
 Helfand, M., Redfern, C.C. Screening for Thyroid Disease: An Update
(Parts 1 & 2). Annals of Internal Medicine, 15 July 1998. 129:141-143,
144-158.
 Kalmijn, S., Mehta, K.M., Pols, H.A.P., Hofman, A., et al. Subclinical
hyperthyroidism and the risk of dementia. The Rotterdam Study.
Clinical Endocrinology (Oxf), 2000; 53: 733-737.
 Ladneson, et al. ATA guidelines for Detection of Thyroid Dysfunction.
Archives of Internal Medicine, 2000; 160: 1573-1575.
 Sawin, C.T., Geller, A., Wolf, P.A., Belanger, A.J., et al. Low Serum
Thyrotropin Concentrations as a Risk Factor for Atrial Fibrillation in
Older Persons. New England Journal of Medicine, 1994; 331(19):
1249-1252.
References
 Shrier, D.K., Burman, K.D. Subclinical Hyperthyroidism:
Controversies in Management. American Family Physician, 2002;
65(3).
 Supit, et al. Interpretation of Laboratory Thyroid Function Tests
for the Primary Care Physician. Southern Medical Journal, 2002;
95(5):481-485.
 Toft, A.D. Subclinical hyperthyroidism. New England Journal of
Medicine, 2001; 345(7):512–516.
 Utiger, R.D. Subclinical Hyperthyroidism – Just a Low Serum
Thyrotropin Concentration, or Something More? New England
Journal of Medicine, 1994; 331(19): 1302-1303.
THANKS!

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