sub clinical hyperthyroidism presented at hmai 2010

8/8/2019 Sub Clinical Hyperthyroidism presented at HMAI 2010

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Dr. Archana Narang, Dr. Saurav Arora,Dr. Latika Nagpal

THYROID CLINIC, SHMC & H

[email protected]


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INTRODUCTION

Subclinical Hyperthyroidism

- Characterized by the presence of low orundetectable plasma TSH concentrationand normal circulating free thyroid

hormones

- Also referred to as mild/earlyhyperthyroidism


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INTRODUCTION

Usually patient is asymtomatic butmay present with some symptoms

such as palpitations, nervousness orweight loss

The severity is assessed by subnormalor undetectable TSH, FT3, FT4 values,

presence of goiter and high uptakethryoid scans (I131, Tc scan)


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SHORT/LONG-TERM

EFFECTSAlteration in cardiac morphology and

function

y Cross-sectional studies demonstrating:y Increased heart rate

y Increased LV mass

y Enhanced LV function

y Impaired diastolic filling

y Increased risk of atrial fibrillation andstroke in older patients


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ADVERSE EFFECTS

Alteration in bone metabolism

y Postmenopausal women with subclinical

hyperthyroidism have increased boneloss

Neuropsychological effects

y Reduced quality of life

yAnxiety, depression

y Increased risk of dementia, Alzheimersdisease


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ACASE OF SUBCLINICAL

HYPERTHYROIDISM

A female aged 32 reported at OPD, INMASwith the complaints of

y Tremors

y Weakness

y Fatigue

y

Bodyache and dyspnoea on exertion for thepast one and half years.

Her complaints started and progresed gradually


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HYPERTHYROIDISM OBS HISTORY:

G5P3A2L3, history of two spontaneous abortions at twoand 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 perVaginum since 6-7months, especiallybetween periods,irritating discharge


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HYPERTHYROIDISMTHERMAL 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


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HYPERTHYROIDISM

MENTAL GENERALS

Angered easily but never expresses herfeelings

Reserved

Husband alcoholic, suppression ofemotions, remains tensed because of it


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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


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HYPERTHYROIDISM Thyroid gland grade-I firm diffuse

Systemic examination revealed

y Proximal muscle weakness is +

y Peri orbital swelling +

All other systems were within normallimits


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HYPERTHYROIDISMBIOCHEMICAL ANALYSIS

TSH - 0.01 IU/ml (low) (Normal range -

0.17-5.32 IU/ml) Normal FT3, FT4

TecnitiumUptake scan - 5.6% (normal limitupto 03%)

Subclinical /Mild Hyperthyroidism


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HOMOEOPATHIC TREATMENT


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HOMOEOPATHIC

APP

ROACH

Prescribed Natrum muriaticum 30 (TDS)after repertorizing and consulting materiamedica

Patient followed up at INMAS every 03weeks to 01 month for more then 03

months during which her two consecutiveTSH reports came to be within normallimits

The patient was then put off

medication and is on observation


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NATRUM MURIATICUMNATRUM MURIATICUM

PARTICULARS

Trembling ofhands

Irritatingleucorrhoea

Delayedmenarche

GENERAL MAKEUP

Thermal towardshot.

Desires Salt(2+),Sour (1+)

Aversion Sweet(2+)

Increased appetite

Sleep: Non-refreshing, easily

disturbed

MENTAL MAKE UP:

Angered easily but neverexpresses her feelings

Reserved in nature

Suppression of emotions,remains tensed because ofalcoholic nature of husband

MENTAL MAKE UP:

Angered easily but neverexpresses her feelings

Reserved in nature

Suppression of emotions,remains tensed because ofalcoholic nature of husband


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NATRUM MURIATICUM FOR

TH

IS

CAS

E GENERAL MAKE UP

y Thermal towards hot.

y Desires Salt(2+), Sour (1+)

yAversion Sweet (2+)

y Increased appetite

y Sleep: Non- refreshing, easily disturbed

PARTICULARSy Trembling of hands

y Irritating leucorrhoea

y Delayed menarche


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NATRUM MURIATICUM FOR

THIS CASE

Ment l e :

y ngeredeasil t neverexpresses erfeelings

y eserved innat re

y Suppressi n femotions, remains tensedecauseofalcoholicnatureofhusband


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MANAGEMENT

Patient is advised to

y Take non Iodized salt

y Take iron rich food like green leafyvegetables, jaggery, black gram, etc

y Light, non spicy, nutritious food

y Maintain local hygiene

y Plenty of water intake


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FOLLOWUPS

The case is being on regular follow upat INMAS

03 months follow up following casetaking with two TSH repeat reportshas been presented here

The important features of the followsups are.


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FOLLOWUPS

Symptomatic/Signs relief:

y Breathlessness relieved gradually and is

absent nowy Tremors hands absent

y Irratitng discharge per vaginum absentnow

y Pulse rate in range of 70-80/bpm.y Pain and swelling in eyes after exertion:

absent.


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FOLLOWUPS

Biochemical evidence:

y 19.12.08: TSH: 0.29 IU/ml (WNL)

y 02.02.09: FT4: 14.03 pM/Ly 02.02.09: TSH: 1.3 IU/ml (WNL)


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FINAL COMMENTS

The patient is Euthyroid clinically andbiochemically at present and is

regular OPD at INMAS


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CONCLUSION

IT IS A CONDITION WHICH AFFECTS THEPATIENT:-

yPHYSICALLY

yMENTALLY

yINTELLECTUALLY

ySOCIALLY

&

yFINANCIALLY

IF NOT TREATED IN TIME


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CONCLUSION

As patients affected by subclinicalhyperthyroidism may have symptoms itcan lead to impaired quality of life

Cardiac morphology and function areaffected in these patients by increasedheart rate, LV mass, enhanced LVfunction and impaired diastolic filling

Untreated subclinical hyperthyroidismmay have untoward effects in young andmiddle-aged therefore early treatment

with indicated Homoeopathic medicinesis recommended


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REFERENCES

Biondi, B., Palmieri, E.A., Fazio, S., et al. Endogenous SubclinicalHyperthyroidism Affects Quality of Life and Cardiac Morphology andFunction in Young and Middle-Aged Patients. Journal ofClinical

Endocrinology and Metabolism, 2000; 85(12):4701-4705.

Helfand, M., Redfern, C.C. Screening for Thyroid Disease: An Update(Parts 1 & 2). Annals ofInternal Medicine, 15 July 1998. 129:141-143,144-158.

Kalmijn, S., Mehta, K.M., Pols, H.A.P., Hofman, A., et al. Subclinicalhyperthyroidism 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 ofInternal Medicine, 2000; 160: 1573-1575.

Sawin, C.T., Geller, A., Wolf, P.A., Belanger, A.J., et al. Low SerumThyrotropin Concentrations as a Risk Factor for Atrial Fibrillation inOlder Persons.New EnglandJournal of Medicine, 1994; 331(19):1249-1252.


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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 MedicalJournal, 2002;95(5):481-485.

Toft, A.D. Subclinical hyperthyroidism.New EnglandJournal ofMedicine, 2001; 345(7):512516.

Utiger, R.D. Subclinical Hyperthyroidism Just a Low SerumThyrotropin Concentration, or Something More?New EnglandJournal of Medicine, 1994; 331(19): 1302-1303.


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THANKS!

sub clinical hyperthyroidism presented at hmai 2010

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