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| Thyroid Dysfunction: The
Homoeopathic Approach II |
| -Dr. Praful
Barvalia |
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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. |
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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.
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Acute organic
reactions: |
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They are usually present
during thyroid crisis, characterized by delirium and fever,
they constitute a grave emergency which warrants urgent interventions.
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Affective and organic Psychoses:
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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. |
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