In today’s talk, we are going to learn about the translational value of one of the largest randomised controlled trials of subclinical hypothyroidism in homeopathy. This study was published in the year 2014.
This was a two-part study. In the 1st part, we had the epidemiological screening in which we screened more than 5000 schoolchildren of Delhi between the ages of 6 and 18 years, and they were subjected to the biochemical investigations, including FT3, FT4, TSH, anti-TPO antibodies and ultrasound of the thyroid gland. So once the epidemiological phase was over, we entered into the phase of clinical trial. So, here we are going to deduce the 6 most important thyroid tips.
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Tip Number 1: Subclinical does not mean undetectable.
- Many times it happens that patients don’t have symptoms. And don’t want to have the investigation done. But what if they have mild symptoms?
- What if they have a family history of thyroid disorders? What if you have a suspicion? Always and always go for the basic routine investigations.
- Once we routinely screened more than 5000 schoolchildren in Delhi, we found that 613 kids had problems. And it’s not a small number.
- At that time, the prevalence rate used to be 6-8%, as reported by different agencies, and we found that it was more than 10%.
- Out of those 613, seventy-six had to be referred to an endocrinologist for further evaluation because they had symptoms, and their thyroid index was beyond the inclusion criteria. And their symptoms were ignored.
- Since we screened them, they were picked up.
- We found that 35% of the kids have mild to moderate symptoms which can be referred to as common symptoms in clinical practice, such as poor concentration, hairball, lack of interest in the studies, headaches, fatigue, and tiredness. weight gain or even dry hairs.
Tip Number 2: Autoantibodies are the warning light for progression.
- We observed that at various places where even the FT3, FT4 and TSH were all within normal limits, their anti-TPO antibodies were raised. This is direct evidence of the autoimmunity, and it starts like this only.
- At this stage, you can correlate these findings with the theory of miasms. Once they are in a psoric state, there may not be any symptoms, but there may be alterations.
- Once these alterations set in, they typically progress to further states, which may include overt hypothyroidism over the course of years. So, these thyroid antibodies act like a radar for early detection of these symptoms. In the study control group, 10.5% of the children went into overt hypothyroidism over the 18-month duration of the treatment. But none of the children in the homoeopathic group developed any problems. And those who developed the problem shared two common factors. Either they had the elevated anti-TPO antibodies or their family history was positive for the thyroid disorders.
Tip Number 3: it is always about individualisation.
- In our study, the individualised care showed a promising biochemical response. Over the 18 months of study, 85% of the kids on homeopathic treatment showed normalcy in their TSH levels. In comparison to 64%, which was in the study control group.
- The recovery in the homeopathic group was more clinically relevant, and it was without any problems. In addition, we saw that 70% of the kids who were autoantibody positive returned to normalcy, compared to 27% of the kids who did not receive the medicines. So additionally, 70% of the kids were treated in comparison to the control group with homeopathy.
- So the result was huge clinical as well as statistically significant data.
Tip Number 4: There is no perfect magical thyroid pill.
- In our study, we offered the individualised constitutional treatment to the kids, but we did encounter certain frequently used and most indicated remedies: Natrum mur, Calcarea carb, Pulsatilla, etc.
Tip Number 5: Regular monitoring is non-negotiable.
- Don’t rely on one report. In our study too.
- We cross-checked each and every investigation and sample. And whenever there was any confusion, we repeated those tests. Just to reduce the errors and bias.
- In the clinical practice too, many times you may encounter a patient who needs repetition in terms of the investigations; always do that. Never ever treat a patient with a suspicion.
- Always and always make a nosological diagnosis, clear the doubts, and then start treating those patients.
- The study monitored the serum FT3, FT4, TSH and anti-TPO antibodies at regular intervals in the whole 18 months of duration of the treatment. And that is the reason we could correlate it statistically because we had a series of readings, and we tried to reduce the bias.
Tip number 6: Know when the intervention is essential.
- Clinical trial protocols are to be followed religiously and ethically.
- In our study too, we had clear-cut inclusion and exclusion criteria, and we followed these criteria throughout the study.
- There should be a clear line of treatment drawn in such patients. The study strictly enforced the… clinical endpoint. and that was TSH greater than 10.
- Whenever there is overt hypothyroidism, the case should be referred to an expert for the analysis and evaluation.
So this study taught us many things.
- This study taught us how to enter the epidemiological phase, how to correlate the findings of the epidemiological phase with the clinical trial, and what to do and what not to do in the clinical setting.
- Although they were part of the research, I think we can practise these clinical findings and keep these clinical findings and learning insights in mind.
- Then our practice in thyroid disorders would be more ethical, and it would be more logical and intellectual.
Disclaimer: The content of this podcast, including text, graphics, images, or any other material, is for informational purposes only and not a substitute for professional and expert advice.”
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