Estimation of Temperamental Changes in Female Teachers with Subclinical Hypothyroid Dysfunction - A Retrospective Observational Study

Introduction

Subclinical hypothyroid dysfunction (SHD) is defined as an elevation in serum thyroid stimulating hormone (TSH) above the upper limit of the reference range 4.5 mIU/L not exceeding 10.0 mIU/L, with normal serum FT4 concentration.¹ Several alternative names have been proposed to describe this condition, which include compensated hypothyroidism, preclinical hypothyroidism, mild thyroid failure, and mild hypothyroidism.²

The prevalence of SHD varies with population, age, sex, race, region, and method of TSH measurement. Its prevalence in large population-based studies in different countries has been reported to be 3% to 10% worldwide.¹ India has an estimated 42 million people suffering from thyroid diseases, with prevalence of SHD as high as 9.4%, with female dominance of 11.4% vs 6.2% in men.²

Science has come a long way in understanding man and diseases. With advancement in quantum physics, purely mechanistic views of diseases are now being questioned and another vital dimension, the mind, which so far was underestimated, is now being recognized as the prime causal factor in a disease phenomenon. Various types of stresses induce release of various stress specific hormones in the body, which triggers the Hypo-Thalamo-Pitutary-endocrine axis to get geared up, which in turn causes hormonal imbalances responsible for diseased conditions.

In this study, an attempt was made to understand, if there exists a relationship between SHD and concurrent temperamental changes on a mental sphere. Dr. Robert HA, in his book “The Principles and Art of Cure by Homoeopathy” stated that the functions of some of the ductless glands which secrete minute quantities of specialized product into the system that has vital bearing on the health, may at times be so minute that it approaches the homoeopathic attenuation which justifies the application of homoeopathic medicines. He further stated that consideration of mental and emotional states while selection of the similimum is the best prescription.³

Homoeopathy, a science, since its inception has acknowledged an existence of a definite relationship between the mind and the body. Central to the current research is an attempt to discover an association between SHD, its physical manifestation and simultaneous temperamental changes, as explained by Robert HA. If an existence of such a relationship is found, further long-term interventional studies can be carried out which may guide the homoeopathic fraternity in selection of homoeopathic similimum precisely.

Aim

To estimate temperamental changes in middle aged female teachers with subclinical hypothyroid dysfunction.

Objective

1. 1. To estimate temperamental changes in middle aged female teachers with subclinical hypothyroid dysfunction.
2. To study an existence of relationship between physical signs & symptoms and simultaneous temperamental changes.

Materials and Methods

Source of data: The subjects were included from A.M Shaikh Group of Institutions and from schools in and around Nehru Nagar, Belagavi.

Study design: Retrospective observational study.

Sampling technique: Interview, questionnaire method.

Selection criteria: Subjects were included based on the inclusion criteria using Zulewski’s clinical score for hypothyroidism. Subjects whose scores were between 3-5 on Zulewski’s rating were provided with self-designed questionnaire to elicit changes in mental sphere. Those subjects who exhibited changes in mental state were further included to estimate temperamental changes along with physical signs & symptoms.

Inclusion criteria

• All female teachers in the age group between 30-44 years.
• Subjects who scored between 3-5 on Zulewski’s clinical score for hypothyroidism and those who showed presence of temperamental changes since the onset of physical complaints.

Exclusion criteria

• Female teachers previously diagnosed and on regular oral levothyroxine medication. 
• Female teachers on medications for other co-existing co-morbidities.
• Pregnant middle-aged females.
• Female teachers on oral contraceptive pills.
• Female teachers with a known case of psychiatric illness and on medications for the same.

Duration of study: Six months (November 2022 - June 2023)

Data evaluation

Based on HA Robert’s temperaments.

Materials used

• Informed consent from subjects.
• Zulewski’s clinical score for hypothyroidism (Table 1).
• Self-designed questionnaire to elicit mental symptoms.

Result

Based on H.A Robert’s Temperaments, subjects were estimated to have temperamental changes, if they could be grouped under any of the following categories:

• Nervous: Quick, anxious and over excited subjects.
• Bilious: Irritability with gastric disturbances. 
• Sanguinous: Congestions and easy flushing which renders red hue to the skin with sudden mood changes.
• Phlegmatic: Sluggish and slow in reaction. Based on self-designed questionnaire, the following results were observed (Table 2)

Discussion

The study reported that subjects showing early signs and symptoms of hypothyroidism, screened and diagnosed using Zulewisk’s clinical scale showed temperamental shifts with the onset of physical symptoms. Further, the study showed that majority of the subjects with SHD were predisposed to have Robert’s phlegmatic temperament (40.96%), followed by nervous (25.30%), bilious (20.48%) and sanguinous (13.25%). The study not only re-confirmed the homoeopathic insights of the mind-body relationship in a disease phenomenon but also threw light on importance of understanding temperamental shifts which can in turn aid in better selection of the homoeopathic similimum. It emphasizes the presence as well as the importance of mental concomitants in a diseased condition.

Scope

Although, there have been several studies on temperaments and homoeopathic prescriptions, selection of remedy based on temperament-guided specific disease conditions can be delved into and standard operating procedures (SOPs) can be constructed based on these studies. Research directed on temperament-based prescriptions can be undertaken and after thorough evaluation, classification of homoeopathic drugs under each temperament can be done, which will enable precision and easy selection of the similimum.

Limitations

• Sample size included in the study was small.
• Classification of homoeopathic drugs under the four temperaments of Robert’s can be challenging.
• Study was conducted on a specified age group and gender.
• The study contradicts homoeopathic principle of selection of individualized homoeopathic drug based on totality of symptoms.

Conclusion

The outcome of this study clearly reinforces Hahnemannian understanding of diseases and emphasizes on need of acknowledging mental changes along with physical signs and symptoms in treating diseases. It also emphasizes that cognizable changes at a physical level can be well appreciated with changes on mental sphere concurrently.

Conflict of interest

None

Acknowledgement

We highly acknowledge and appreciate the schools that have allowed us in carrying out the study.