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wWEBSITE : www.ijacare.in e-ISSN No.: 2457-0443
INTERNATIONAL JOURNAL OF AYUSH CASE REPORTS (IJA-CARE)
Int. J. of AYUSH Case Reports. January- March 2024; 8 (1) 133
Individualized Homoeopathic Treatment of a Geriatric Case of Goitre- A
Case-Report
Sourita Das, 1* Md Intekhab Alam, 1 Saurav Biswas2
1Post Graduate Trainee, Department of Homoeopathic Materia Medica, 2 Lecturer, Department
of Practice of Medicine, Mahesh Bhattacharyya Homoeopathic Medical College and Hospital,
West Bengal, India.
ABSTRACT:
Goiter is defined as an enlarged thyroid gland (>20-25g), that can be diffuse/simple or nodular.
Thyroid nodules are common, perceived by palpation in at least 4 percent of the population in
iodine-sufficient areas and more than half of patients by using ultrasonography, with the majority
being asymptomatic. Nodular goitre is one of the most common endocrine problems in the world
today, affecting up to 12% of the world's population and 170 million people in India. Females are
more likely to suffer from goitre than males of the same age group with a sex ratio Female: Male
= 24:1. Diagnosis of a case or goitre is confirmed by ultrasonography and/or thyroid scintigraphy.
This case report summarizes the improvement seen in a 72-year-old lady diagnosed with cystic
colloidal goitre with calcification and thickened isthmus (volume of the right lobe was 25cc with
calcification of 0.7cm & 0.5 cm, volume of the left lobe was1.8cc) with the help of Causticum 200,
which was chosen guided by the principles of homoeopathy, and was prescribed only once during
treatment. At the end of 9 months after the commencement of treatment, radiological reports
showed the volume of the right lobe of the thyroid was 2.94cc, the volume of the left lobe was
1.32 cc, the isthmus was normal, both lobes showed evidence of calcification but exact
measurement was not available. Clinically goitre was not visible to the naked eye. Thus, the
effectiveness of the minimum dose of the correctly chosen simillimum is evident, as observed in
this case.
KEYWORDS: Causticum, Geriatric population, Goitre, Individualised Homoeopathic Medicine,
MONARCH.
___________________________________________________________________________
Received: 26.01.2024 Revised: 20.02.2024 Accepted: 9.03.2024 Published: 20.03.2024
___________________________________________________________________________
Creative Commons Attribution-NonCommercial-No Derivatives 4.0 International License
© 2024 International Journal of AYUSH Case Reports | Published by Tanaya Publication, Jamnagar.
___________________________________________________________________________
INTRODUCTION:
*Corresponding Author
Dr. Sourita Das
Post Graduate Trainee, Department of Homoeopathic Materia
Medica, Mahesh Bhattacharyya Homoeopathic Medical College
and Hospital, West Bengal, India.
E-mail: souritadas@gmail.com
Quick Response Code
Das S. etal. Individualized Homoeopathic Treatment of Geriatric Goitre
______________________________________________________________________________________________________________
Int. J. of AYUSH Case Reports. January- March 2024; 8 (1) 134
INTRODUCTION:
Goiter refers to a generalized enlargement of
thyroid gland (>20-25g), that can be
diffuse/simple or nodular. [1,2] People
affected by goitre often present with a non‐
symmetrical enlargement of the thyroid gland
with visible swelling in the anterior aspect of
the neck. One or more nodules can be
recognized.[2] Thyroid nodules are common,
perceived by palpation in at least 4 percent of
the population in iodine-sufficient areas and
more than half of patients by using
ultrasonography, with the majority being
asymptomatic. They may be associated with
local compressive symptoms, causing
dysphagia and disordered thyroid hormone
production as well as thyroid cancer (chances
of which may vary from 3%-36%).[3]
Endemic growth in cases of goitre is a
significant problem affecting up to 12% of
the world population. Nodular goitre is one
of the most common endocrine problems in
the world today.[4] The magnitude of the
thyroid goiter problem in India is far greater
than what it was estimated earlier, affecting
about 170 million people in the country.[4]
Multi-nodular goitre is more common in
females and a majority are in the age group of
31-39 years.[5] Females are more likely to
suffer from goitre than males of the same age
group with a sex ratio Female: Male = 24:1.[5]
Worldwide, iodine deficiency is the most
common cause of goitre.[6]
Simple/Diffuse goitre usually presents
between the ages of 16 and 26 years.[6] The
goitre is soft and symmetrical and is enlarged
to two to three times the normal. It is
generally painless with no lymphadenopathy
or overlying bruit and occasionally there is a
tight sensation in the neck, particularly when
swallowing. T3, T4, and TSH are normal and
no thyroid autoantibodies are detected in the
serum. It generally regresses on its own. In
some cases, however, the unknown stimulus
to thyroid enlargement persists and, as a
result of recurrent episodes of hyperplasia
and involution during the following 10-20
years, the gland becomes multinodular with
areas of autonomous function. As these
nodules grow at varying rates and secrete
thyroid hormone ‘autonomously’, thereby
suppressing TSH-dependent growth and
function in the rest of the gland. Ultimately,
complete suppression of TSH occurs in
about 26% of cases, with T4 and T3 levels
often within the reference range but
sometimes elevated.7 Multinodular goitre is
usually diagnosed in patients presenting with
a large goitre with or without tracheal
compression, or sudden painful swelling
caused by haemorrhage into a nodule or cyst.
When the goitre is nodular or lobulated on
palpation it may extend retrosternally. Very
large goitres may cause mediastinal
compression with stridor, dysphagia, and
obstruction of the superior vena cava.
Hoarseness due to recurrent laryngeal nerve
palsy can occur (but it is far more suggestive
of thyroid carcinoma). [6,7]
Diagnosis of a case or goitre is confirmed by
ultrasonography and/or thyroid scintigraphy.
In case of contemplation of intervention, a
CT scan or MRI of the thoracic inlet should
be performed to quantify the degree of
tracheal displacement or compression and
the extent of retrosternal extension. Nodules
should be evaluated (FNAC) for the
possibility of thyroid malignancies.
Hormonal assay should be done to exclude
hypothyroidism or thyroid toxicity. [ 6,7]
The conventional approach to treat goitre is
to wait and watch when it is asymptomatic
along with an annual thyroid function test as
the natural history is progression to a toxic
multinodular goitre. surgical excision is
indicated in case of compressive symptoms.
Das S. etal. Individualized Homoeopathic Treatment of Geriatric Goitre
______________________________________________________________________________________________________________
Int. J. of AYUSH Case Reports. January- March 2024; 8 (1) 135
Hormonal therapy does not help in
regression of goitre, even when it does, it is
limited to 6-12 months. [6,8] Homeopathic
treatment of goitre has shown some
beneficial outcomes in the recent past, where
patients have shown improvement without
the need for surgical intervention. [9-12] Like all
other aspects of homoeopathy here also the
possible mechanism of action of the drugs is
still not explored. We intend to report this
case report as we want to emphasize the
exploration of probable action of
homoeopathic medicines in case of goitre.
Not only that, proper scientific exploration
of probable action will help us to understand
the scope and limitations regarding the
usefulness of these ultra-diluted medicinal
preparations.
CASE REPORT:
Patient Information:
An elderly lady visited OPD 2, of Mahesh
Bhattacharyya Homoeopathic Medical
College and Hospital, Howrah, West Bengal,
on 11 August, 2021. She complained of a
swelling on the right side of the neck, visible
for last 2 months along with pain and
discomfort, that came along at a later period.
Without further case-taking, she was advised
for USG of neck and blood for T3, T4, and
TSH.
She came with the reports on 18 August
2021. As the reports suggested idiopathic
goitre, further case-taking was done. She had
suffered from jaundice and malaria in the
past, and currently, she takes medications for
hypertension. She also has features of OA.
Both her attendants and the patient cannot
recall any swelling before 2 months. The
onset was painless and the pain and
discomfort began about 16 days before the
first visit. No treatment has been adopted so
far. She could not recall much about her
family history.
General Symptoms (mental and physical)
On query, her attendants remarked that she
is angered easily, and recently she gets
irritated quite easily. On that, she remarked
that she has to protest against any
wrongdoing if she sees it, be it towards her or
others. She prefers cloudy weather but fears
a thunderstorm.
Physical general symptoms were taken as
follows-
▪ Appetite- good, can’t tolerate hunger
▪ Desire- spicy, hot, sour, warm, rice
▪ Aversion- N/P
▪ Intolerance- coconut, and poppy
seeds; cause dyspepsia
▪ Thirst- increased, takes large
quantities at a time
▪ Tongue- dry, flabby with multiple
transverse cracks
▪ Sleep- disturbed, wakes up with
palpitation
▪ Sweat- scanty, mostly on the back,
not offensive
▪ Stool- hard, constipated, irregular.
Has to take purgatives
▪ Urine- clear, sometimes unable to
hold it on coughing or sneezing
▪ Thermal reaction- chilly
On Examination, the swelling on the right
side of the neck was hard, about 4 cm in
diameter, and movable with no attachment to
the overlying skin. There was no deviation of
the trachea. Carotid pulsation was within
normal limits (WNL). There was no venous
engorgement in the neck. Neck glands were
not palpable. Figure 1 On auscultation there
was no overlying bruit present. Also, fine
tremors of the hands were noted. As the
patient was from the geriatric group, the
tremor could be age-related. Also, as it was a
Das S. etal. Individualized Homoeopathic Treatment of Geriatric Goitre
______________________________________________________________________________________________________________
Int. J. of AYUSH Case Reports. January- March 2024; 8 (1) 136
suspected case of goiter, we needed to rule
out hyperthyroidism.
A provisional diagnosis of goitre was made
and the patient was advised for USG of neck
and blood for T3, T4, and TSH. USG of the
neck suggested cystic colloidal goiter of thyroid.
Blood biochemistry showed: T3-1.4ng/ml,
T4- 9.6µg/dl, TSH- 1.37IU/ml. [Figure 7]
USG evidence supported the goitre to be a
benign growth. Thus, the FNAC of the
swelling was not performed to rule out
malignancy, considering the age and financial
background of the patient.
Analysis of the Case:
After analysing the case, characteristic mental
and physical symptoms were taken to form
the totality of symptoms and individualize
the case. Taking the characteristic symptoms
into account, repertorisation Figure 9 was
done with Kent’s Repertory [13,14] using
Zomeo 3.0. Lycopodium was the repertorial
choice with 15 points covering 5 rubrics,
followed by Causticum with 14 points
covering all 7 rubrics, Phosphorus, Silicea, and
Sulphur, each got 14 points covering 5 rubrics.
The final selection of remedy was made by
consulting the materia medica based on the
symptoms collected during case-taking.[15]
THERAPEUTIC INTERVENTION:
Based on the totality of symptoms Causticum
200/2 doses were prescribed on 18th August
2021. The patient was called for follow-up
after 1 month. She was advised to have
regular follow-ups at an interval of 1 month.
Gradual improvement in symptoms was seen
and thus placebo was given at each follow-
up. [Table 1]
The Modified Naranjo Criteria
(MONARCH) was used to measure the
improvement following the treatment with
homeopathic medicine and the total score
was 8. [16] [ Table 2]
Table 1: Follow-up:
Date of
visit
Symptoms
Medicines
Prescribed
18 August,
2021
Complaint of a swelling on the right side of the neck, visible
since last 2 months along with pain and discomfort.
Causticum
200/2D
OD X 2 days
followed by
PLACEBO for 1
month
16
September,
2021
Pain had reduced considerably. On examination the swelling now
felt soft. Size seemed similar to the prior visit. She complained of
constipation and dyspepsia.
PLACEBO
19 January,
2022
The patient came after 3 months. There was no pain in the swelling
and it seemed reduced visually. She complained of pain & burning
in the lower limbs < in the evening. She also complained of
prostration and vertigo on rising from bed. She was advised to
follow a regular diet and not to skip her meals.
PLACEBO
Das S. etal. Individualized Homoeopathic Treatment of Geriatric Goitre
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Int. J. of AYUSH Case Reports. January- March 2024; 8 (1) 137
2 February,
2022
The swelling was soft and the size seemed reduced visually. The
pain in the limbs were reduced. Vertigo was not present.
PLACEBO
30 March,
2022
The swelling had reduced considerably. No pain present. There is
no prostration. Stool is regular, 1-2 times daily. She sleeps soundly
now.
PLACEBO
2 May,
2022
No swelling visible, no pain present. Patient has good appetite,
regular bowel movements, and sleeps soundly now.
PLACEBO
Table 2: Modified Naranjo Criteria (MONARCH) Score:
Items
Yes
No
Not
Sure
1. Was there an improvement in the main symptom or condition, for which the
homeopathic medicine was prescribed?
+2
2. Did the clinical improvement occur within a plausible time frame relative to the drug
intake?
+1
3. Was there a homoeopathic aggravation of symptom? (Need to define in glossary)
0
4. Did the effect encompass more than the main symptom or condition, i.e., were other
symptoms, not related to the main presenting complaint, improved or changed)?
+1
5. Did overall well-being improve? (Suggest using a validated scale or mention about
changes in physical, emotional and behavioral elements)
+1
6: (a) Direction of cure: Did some symptoms improve in the opposite order of the
development of symptoms of the disease?
0
(b) Direction of cure: Did at least one of the following aspects apply to the order of
improvement of symptoms:
• From organs of more importance to those of less importance?
• From deeper to more superficial aspects of the individual?
• From the top downward?
0
7. Did “old symptoms” (defined as non-seasonal and non-cyclical symptoms that were
previously thought to have resolved) reappear temporarily during the course of
improvement?
0
8. Are there alternate causes (other than the medicine) that – with a high probability –
could have caused the improvement? (Consider known course of disease, other forms
of treatment and other clinically relevant interventions)
+1
9. Was the health improvement confirmed by any objective evidence? (e.g.,
investigations, clinical examination, etc.)
+2
10. Did repeat dosing, if conducted, create similar clinical improvement?
0
Total score- 8
Das S. etal. Individualized Homoeopathic Treatment of Geriatric Goitre
______________________________________________________________________________________________________________
Int. J. of AYUSH Case Reports. January- March 2024; 8 (1) 138
Figure 1: Swelling on neck as seen on 18-
08-2021
Figure 2: -Reduction in swelling clinically
seen on 16-09-2021
Figure 3: -Reduction in swelling as seen
on 19-01-2022
Figure 4: - Swelling of neck reduced to a
great extent as seen on 02-02-2022
Figure 5: -No swelling visible on the neck
as on 30-03-2022
Figure 6: -No swelling over the neck 02-
05-2022
Das S. etal. Individualized Homoeopathic Treatment of Geriatric Goitre
______________________________________________________________________________________________________________
Int. J. of AYUSH Case Reports. January- March 2024; 8 (1) 139
Figure 7: Day 1- 18TH August, 2021
Figure 8: Final Visit- 2ND May, 2022
Figure 9: Repertorization:
DISCUSSION:
The thyroid gland and its diseases have been
known in clinical practice since the time of
Hippocrates and are still an important subject
of interest. Normal thyroid function is
necessary for the physiological activity of
most organs. Management of thyroid
problems poses a great challenge to the
medical fraternity and needs to be studied
vastly. Colloid goitres are a common variety
Das S. etal. Individualized Homoeopathic Treatment of Geriatric Goitre
______________________________________________________________________________________________________________
Int. J. of AYUSH Case Reports. January- March 2024; 8 (1) 140
of benign thyroid lesions. Utmost care
should be taken while differentiating them
from other neoplastic growths including
malignant varieties. The safest and surest way
to investigate such cases is ultrasonography
of the neck along with serum thyrotropin.
The patient’s history and proper physical
examinations should be conducted during
the initial evaluation and case-taking. The
conventional approach in asymptomatic is to
observe the patient with annual thyroid
function tests, followed by surgery.
Thyroidectomy brings on several
complications for the patient includes
hypoparathyroidism and recurrent laryngeal
nerve injury.[17] Further complete
thyroidectomy patients require life-long
support of thyroid supplements.
Homoeopathy can be the answer to many
chronic diseases where surgery is the
conventional option. Patients of goitre have
shown positive results after opting
homoeopathic treatment. [9-12] In this case the
patient was treated with Causticum 200/2D,
followed by a placebo for 9 months. She
started showing improvement from the
second visit which encouraged us to observe
the effects of Causticum and not repeat or
change the medicine. Causticum was chosen
based on the totality of the case. Thus, the
effectiveness of the minimum dose of the
correctly chosen simillimum is evident, as
observed in this case.
At the end of 9 months, there was no visible
swelling of the gland. Photographic evidence
of the reduction in the size of swelling on the
neck corroborates the findings. [Figures 1-6]
The USG reports suggested a decrease in the
size of the thyroid gland from 25cc on the
right side to 2.94cc and 1.83cc on the left to
1.32cc. [Figures 7-8] USG evidence
supported the goitre to be a benign growth.
Thus, the FNAC of the swelling was not
performed to rule out malignancy,
considering the age and financial background
of the patient. During treatment, other
physical symptoms as well as general
symptoms of the patient had also shown
marked improvement. The patient was
irregular in her follow-ups; thus, a detailed
case study was needed in each of the visits to
track the improvement. The patient further
discontinued the follow-ups after May, 2022.
The USG in the final visit showed reduction
in the size of the goiter, but it was not
completely resolved. The calcified nodules
persisted, though reduced in size. Remedies
like Silicea, or Calcarea could have been used
next in line based on the totality of the
patient, to clear the case by dissolving the
calcifications. As no more follow ups were
available, the efficacy of such drugs could not
be tested in this particular case.
In this case, the total outcome score as per
Modified Naranjo Criteria was +8 Table 2.
This explicitly shows the positive causal
attribution of the individualized
homeopathic treatment in this case of colloid
nodular goiter.
In the era of most advanced medical services,
Hahnemann’s dictum of the holistic
approach towards treatment rather than
identifying diseases merely by their
pathological features still holds. [18] It can thus
be justified to say that in several cases surgery
may not be required at all and homoeopathy
can bring back the homeostasis required to
maintain a healthy functioning of the
organs.[19] Case reports like these encourage
physicians of the homeopathic fraternity and
contribute to the evidence that shows the
positive results of individualized
homoeopathic treatment.
CONCLUSION:
Das S. etal. Individualized Homoeopathic Treatment of Geriatric Goitre
______________________________________________________________________________________________________________
Int. J. of AYUSH Case Reports. January- March 2024; 8 (1) 141
This case report shows the improvement of
an elderly patient of goitre with the help of
Causticum 200, over 9 months. Evidence
shows the reduction in the size of the goitre.
During her treatment improvement in her
general health was also noticed and recorded.
Limitations of the study:
USG evidence supported the goitre to be a
benign growth. Thus, the FNAC of the
swelling was not performed to rule out
malignancy, considering the age and financial
background of the patient.
Declaration of patient consent:
The patient’s written consent has been taken
for treatment and publication of data without
disclosing the identity of the patient.
Acknowledgment:
We thank the Department of Practice of
Medicine and Homoeopathic Materia
Medica. We also thank Dr. Avirup Basu and
Dr. Pritam Goswami for their insight and
guidance.
Conflict of interest: The authors declares
that there is no conflict of interest.
Guarantor
:
The corresponding author is the
guarantor of this article and its contents.
Source of Support: None
How to cite this article:
Das S, Alam MI., Biswas S. Individualized
Homoeopathic Treatment of a Geriatric
Case of Goitre: A Case-Report Int. J.
AYUSH CaRe. 2024;8(1): 133-142.
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