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Thyroid Dysfunction: The Homoeopathic Approach II
-Dr. Praful Barvalia
 
We have earlier examined how clinico-immuno-pathological correlation with theory of chronic disease gives us better insight to understand the intrinsic nature of thyroid disorders. This will have its own impact on appreciation of susceptibility and posology gormulations.

In this article, we are discussing psychological and psychosomatic dimensions in thyroid disorders. This knowledge has far reaching impacts on case taking, case analysis and case anamnesis.

Articles and interviews of academicians, eminent educationists and research workers from the profession throw ample light on various aspects.
Articles and interviews of academicians, eminent educationists and research workers from the profession throw ample light on various aspects.
A 43-year-old female, was brought to me by her family members because of her suicidal impulses and violence. She was on psychotropic drugs. She had a voracious appetite with fine tremors that aroused the suspicion of hyperthyroidism, which got confirmed through investigation. Further inquiry revealed an individual with a sense of responsibility and over sensitivity. Thus, in thyroid disorders we encounter lots of psychiofactors coming up as expressions as well as causation.

Psychodynamic factors for hyperthyroidism:
Intense aggression which is suppressed -state of vexation.
Accentuated sense of responsibility.
Grief, Separation.
We will discuss in details various psychodynamic factors after studying the illustrative cases.

It is worthwhile examining psychological/psychiatric accompaniments of thyroid disorders :
Emotional disturbances are fairly common in thyrotoxicosis. States of extreme anxiety or hostile irritability may emerge as a direct outgrowth of the heightened emotional tension, or paranoid features may appear as part of the disturbed mental state. Also organic and functional psychosis sometimes accompany hyperthyroidism. Occasionally they are the presenting features and lead directly to psychiatric referral.

Acute organic reactions:
They are usually present during thyroid crisis, characterized by delirium and fever, they constitute a grave emergency which warrants urgent interventions.

Affective and organic Psychoses:
Amongst these, mania is said to be more frequent than depression, and often the progression to mania can be seen as a direct outgrowth from the characteristic mental changes of the endocrine disorders.

The diagnostic distinction between the affective and schizophrenic reactions is often blurred, and an admixture of organic psychiatric features is relatively common. A seemingly schizophrenic psychosis may sometimes represent organic disorder. Lieshmann quotes the following case:

A man of 28 developed short-lived schizophrenia, like an illness with a paranoid delusional state, ideas of reference and influence and auditory and visual hallucinations. Orientations and memory were apparently intact, but a contribution due to organic cerebral disorder was suggested by the presence of deja vu and panoramic memory at the height of the illness.

Psychotic developments have been reported in upto 20% of the cases. The differential diagnosis between hyperthyroidism and anxiety neurosis is a classical and often a difficult exercise. The presenting mental symptoms can be virtually identical in both conditions. Both show tachycardia, fine finger tremors, palpitations and loss of weight, and both may appear to have been precipitated by stressful events. Sometimes previous neurotic symptomatology in thyrotoxicosis patients and their families causes further difficulties in diagnosis. Physical symptoms and signs are most important in indicating thyrotoxicosis and should usually be referred to in doubtful cases. The important amongst them in the descending order of discriminating value are:

Sensitivity to heat and preference for cold.

Increased appetite.

Loss of weight.

Sweating.

Palpitations.

Tiredness.

Nervousness.

Dyspnoea on effort.

Cardiac arrhythmia (Chiefly auricular fibrillation).

Hyperkinetic movements.

Tachycardia exceeding 90/min.

Palpable thyroid gland.

Bruit audible over thyroid.

Exopthalmos.

Lid retraction.

Hot hands.

Lid lag.

Fine finger tremors.

Thus we see how closely anxiety neurosis simulated amongst such diagnostically difficult cases of hyperthyroidism will usually be readily suspected when for cold, while classical signs of exopthalmos, lid retraction and lid lag will classify the situation when such are present. But the most decisive feature in differentiating the two conditions in the preservation or otherwise of appetite in the face of steady loss of weight. In hyperthyroidism appetite is characteristically increased whereas in anxiety statures it is reduced.

Alcoholism may be wrongly blamed for the tremors and emotional liability of hyperthyroid patients and should thus be carefully scrutinized when suspected.

An interesting aspect of hyperthyroid patients is that during treatment with antithyroid drugs such as carbimazole, acute organic psychosis may make its first appearance, presumably on response to the toxic effects of drug induced hypothyroidism. In some cases, schizophrenia like psychoses make an appearance at such a time. The acute organic psychosis responds rapidly as the thyrotoxicsis covers under control, but affective and schizophrenic illness run a more valuable course. These need additional treatment in their own right, and the final outcome may vary according to the degree of constitutional vulnerability of the patient.