[Downloaded free from http://www.ijrh.org on Thursday, August 19, 2021, IP: 14.139.55.

162]

CASE RECORD

A case of Colloidal Nodular Goiter

Bindu Sharma*

Most thyroid nodules are asymptomatic. Visible nodules are of great concern to the patient because
of the cosmetic embarrassment they cause. Affected patients are euthyroid i.e. serum T3, T4 & TSH
are normal. A case of colloidal nodular goiter presented at Regional Research Institute (RRI) (H),
Shimla. Her thyroid profile was within normal range and Fine Needle Aspiration Cytology was clearly
suggestive of colloidal nodular goiter. Partial thyroidectomy was advised due to cosmetic reasons.
The fear of surgery brought the patient to RRI (H), Shimla for treatment. She was treated with
homoeopathic medicines following holistic concepts of Homoeopathy and the result was complete
disappearance of Thyroid nodule. Sulphur initiated the action and Lycopodium completed the cure.

Keywords: colloidal nodular goiter; partial thyroidectomy; sulphur; lycopodium; euthyroid

Introduction The present case shows the scope of homoeo-

pathic intervention in this surgical disease.
Goiter is an enlargement of thyroid gland caused
by compensatory hyperplasia & hypertrophy of the Case Summary
follicular epithelium which occurs sporadically and
usually of unknown etiology. Nodular goiter presents A perimenopausal patient, 42 years of age, with
rarely before middle age and female preponderance visible swelling of the thyroid gland (Right lobe) for
is established1. It is a clinical entity characterized by the last 4 years presented at RRI (H), Shimla in Feb.
subsequent growth, structural or functional 2007. She was suffering from hot flushes, night sweats,
transformation of one or more areas within the normal anxiety, depression, pruritus vulvae, vaginal discharge
thyroid tissue. Multi-nodular goiter is benign, whereas and decreased sexual desire. But her main concern
solitary nodules may be malignant. So in patients was the swelling of Thyroid gland. There was no H/O
presenting with a solitary nodule, malignancy must be dysphagia, dyspnoea, hoarseness, loss of weight,
ruled out. In all patients with solitary nodule it is diarrhea etc. She was admitted to a Govt. hospital for
important to measure serum T3, T4, and TSH 2 though surgery but she backed out at the last moment and
most useful is fine needle aspiration of the nodule. If a decided to take homoeopathic treatment. She had
colloid goiter is small, and is causing no obvious under gone Thyroid Function Tests (TFT), Fine Needle
symptoms, surgery is not really necessary, and the Aspiration Cytology (FNAC) and USG of Thyroid gland.
indications for its removal are only cosmetic. If there All her investigations pointed to the diagnosis of
is dyspnoea or dysphagia, or the gland is large, Colloidal Nodular Goiter. Her symptoms included:
subtotal thyroidectomy is indicated, but is seldom
urgent. • Anxiety: worried about minor matters, slightest
noise, even quarrel amongst her children
We find sufficient homoeopathic literature for the aggravated her complaints and made her irritable.
treatment of goiter but there is a lack of evidence based
• Depression: sad, morose, shy, timid, doesn’t talk
documented case records for therapeutic management
much, irritable, mood despondent, she seldom
of thyroid nodules.
laughed. Weeping on being thanked.
• Flushes of heat surging up from chest and neck
Address for Correspondence:
Dr. Bindu Sharma with mild redness of face and desire to throw off
Asstt. Director (H) covering.
Central Council for Research in Homoeopathy
• Irregular scanty menses, for more than 6 months.
61-65, Institutional Area, Janakpuri,
New Delhi -110058 • Fullness in right breast with thin milky discharge
Email: [email protected] from right nipple.
Indian Journal of Research in Homoeopathy
Vol. 5, No. 2, April - June, 2011
40
[Downloaded free from http://www.ijrh.org on Thursday, August 19, 2021, IP: 14.139.55.162]

A Case of Colloidal Nodular Goiter

Bindu Sharma

• Anal itching worse at night. MENSTRUAL HISTORY

• Dry heat in palms and soles.
Onset of menarche was at the age of 15yrs. Earlier
• Reduced sexual desire. her menses were irregular, scanty and delayed with
dark brown color. Each menstrual cycle was preceded
Her vasomotor symptoms, anxiety, irritability and by fullness and heaviness of breasts.
depression were suggestive of climacteric distress
(TFT were normal). She was recommended certain OBSTETRIC HISTORY
investigations which included “hormonal assay” (FSH),
complete haemogram, and lipid profile. P/V and P/S Nothing significant
examination and PAP smear were done to rule out
Cervical Intraepithelial Neoplasia (CIN) & USG pelvis ASSOCIATED COMPLAINTS
to rule out any pelvic pathology. Keeping in view the
milk like discharge from nipple, she was advised serum Enterobiasis, anal itching<night.
prolactin to rule out prolactinoma. All her reports were
within normal range except FSH which was raised as PHYSICAL MAKE-UP
she was in perimenopausal age group.
Thin, short stature with dark, unclean dirty looking
PAST HISTORY: H/O recurrent folliculitis complexion.

TREATMENT HISTORY GENERALS

Though she had Euthyroid status, she had been Mental: weeping++, irritability++, frightened+ trifles
prescribed Eltroxin 50mg ODx15 days and thereafter at, fear of being alone+, sensitivity +++ (even to door
100mg ODx15 days but no subsequent change was bell or bang of door), sluggish+, reserve+ Physical:
seen in her complaints. Burning heat of palm & soles, desire for sweets+++,
warm drinks etc., offensive discharges, sweat stains
FAMILY HISTORY the clothes yellow and weakness+++ Thermal
reactions: Chilly patient but burning heat in palms &
Father - expired at the age of 64 years, as he soles.
suffered from CA lungs (was a chronic smoker).
Mother-had been diagnosed with OA knee joints GENERAL EXAMINATION
and oesophageal varices. Pallor: Mild
Oedema-Nil
Sister- suffering from hypotension. Pulse-72/min
B.P-110/70 mm of Hg
PERSONAL HISTORY Hirsutism- Nil
Weight-51.5 kg
Not significant.

Table 1: Investigations

TESTS RESULTS REFERENCE RANGE

1 FSH 19.59mIU/mL 2.50-10.20 mIU/mL

2 HAEMOGRAM
Haemoglobin 10 gm% 12-14gm%
TLC 8600 4000-11000
DLC P75,L22,E2,M1
3 BLOOD SUGAR (FASTING) 84mg/dL 70-110 mg/dl
4 LIPID PROFILE
Cholesterol 129mg/dL (147-200mg/dL)
Triglycerides 80mg/dL (<150mg/dL)
HDL 37mg/dL (45-70)mg/dL)
LDL 16mg/dL (10-32mg/dL)
VLDL 76mg/dL (<100mg/dL)

USG (Pelvis): suggestive of normal study

F N A C (Thyroid):

41 Indian Journal of Research in Homoeopathy

Vol. 5, No. 2, April - June, 2011
[Downloaded free from http://www.ijrh.org on Thursday, August 19, 2021, IP: 14.139.55.162]

A Case of Colloidal Nodular Goiter

Bindu Sharma

GYNAECOLOGIAL EXAMINATION: Within normal 3. Heat, foot, sole night

range. 4. Itching, around anus, warmth of bed
INVESTIGATIONS : 5. Irritability, alone when
6. Company, desire for
SNAC - Microscopic Examination of thyroid shows 7. Thread worms
abundant colloid (thin & thick), follicular epithelial cells
in the form of sheets, papillae & clusters with stromal 8. Desires, sweets
fragments, involuntary & hyperplastic follicular 9. Sweat stains the clothes yellow
epithelial cells, free flare appearance, scattered base 10. Swelling thyroid gland
nuclei, macrophages, hurtler’s cells, lymphocytes &
haemorrhagic background. The case was repertorized using Synthesis
repertory in RADAR 7.1 software. 3 (Fig.1) On
USG (Thyroid): Dated: 28/06/06 Rt. Lobe of repertorization, Arsenic covered 5 rubrics while
thyroid shows a cystic lesion of size 20mm showing a Lachesis, Sulphur, Lycopodium, Phosphorus, Sepia,
nodule inside. It is well defined, shows echogenic Calc. carb., Merc. and Petroleum covered 4 rubrics
calcification of its walls. Lt. lobe of thyroid as well as each. Considering the physical make-up of the patient
isthmus are normal. No cervical Lymphadenopathy. and past history of the patient, Sulphur was selected
as the First prescription. The follow up visits are shown
Treatment Plan in Table-2
USG (thyroid): Dated 12/3/08
Her complaints were recorded after taking
thorough history as per the principles of Homoeopathy. Rt lobe of thyroid measures 3.4x1.2cm
After analysis and evaluation, her symptoms were Lt. Lobe measures 3.2x1.2cm
converted to relevant rubrics for repertorization as
given under: There is small well defined hypoechoic nodular
lesion in right lobe of thyroid gland of the size 1.0x 1.0
1. Heat flushes, climacteric during cm. (Fig.2)
2. Heat, hand, palm, dry heat

Fig.1

Indian Journal of Research in Homoeopathy

Vol. 5, No. 2, April - June, 2011
42
[Downloaded free from http://www.ijrh.org on Thursday, August 19, 2021, IP: 14.139.55.162]

A Case of Colloidal Nodular Goiter

Bindu Sharma

Table 2: Follow up visits

Date Medicines Doses Remarks

8.03.07 Sulphur 30 Single dose 1st prescription

Placebo & BD
21.03.07 Sulphur 30 Single dose No change noticed in any of the symptoms
20.04.07 Sulphur 200 Single dose No change noticed in any of the symptoms
Placebo BD
17.05.07 Sulphur 1M Single dose No change noticed in any of the symptoms
05.06.07 Sulphur 1M Single dose Anal itching persists, burning palms & soles no change, milk in breast present
03.07.07 Sabadilla 6 9 Doses Burning palms & soles no change, milk in breast present, hot flushes
& night sweat better, swelling in neck reduced in size. However, the
patient complains of sneezing, watery nasal discharge and pain in throat
ameliorated by swallowing warm water.
27.08.07 Nuxvomica 6 9 Doses Having diarrhea with colicky pain in abdomen with ineffectual urge for stool.
19.10.07 Placebo BD Discharge from nipple present, burning heat in palms soles better, no
anal itching. Size of swelling in neck not reducing further.
15.12.07 Rhus tox 6 9 Doses Complaining of fever, generalized body pain, chill and dry cough. Tongue
shows red triangular tip.
10.01.08 Sulphur 1M 1 dose Discharge from right nipple present, burning heat in palms soles better, no
anal itching. Anxiety and hot flushes better. Size of swelling in neck
not reducing further
12.03.08 Placebo BD Though there is symptomatic improvement, the patient is getting restless
as there is no further reduction in size of the swelling of the neck which
is her major concern. Patient is advised to get USG of thyroid gland.

Fig. 2
Report – Simple nodular goiter or Benign 3. Frightened, trifles, at
adenoma. 4. Fear, alone, of being
5. Food, sweets, desire
She was re-interrogated and following rubrics were 6. Heat, hand, palm, dry heat
taken into consideration for repertorization of her case. 7. Heat, foot sole
1. Weeping, thanked, when 8. Milk, Non pregnant women in
2. Irritability, menses, before 9. Discoloration, dirty looking

43 Indian Journal of Research in Homoeopathy

Vol. 5, No. 2, April - June, 2011
[Downloaded free from http://www.ijrh.org on Thursday, August 19, 2021, IP: 14.139.55.162]

A Case of Colloidal Nodular Goiter

Bindu Sharma

The case was repertorized using combined repertory in CARA Professional v.1.4.4 (Fig. 3)

(Fig. 3)

Lycopodium was prescribed as per the follow-up schedule given in Table 3

Table 3: Follow up visits

Date Medicines Doses Remarks

15.03.2008 Lycopodium Single Dose

30 Placebo BD
26.04.2008 Lycopodium Single Dose No apparent change was observed on any parameter
30 Placebo BD
05.06.2008 Lycopodium Single Dose There is some reduction in the milky secretion from the right nipple.
30 Placebo BD The patient reports mild change in the size of thyroid swelling too.
07.07.2008 Placebo BD Patient reports improvement in anxiety, irritability, burning heat in palms
and soles. Nodular swelling of neck reducing.
12.08.2008 Placebo BD Status same as on last visit
29.09.2008 Lycopodium Single Dose The patient reports no further reduction in the size of thyroid
200 Placebo BD swelling. Discharge from nipple also same.
31.10.2008 Lycopodium Single Dose The patient says, “It appears I will have to go for surgery only”. Everyone
200 Placebo BD at home also is advising me not to waste any more time.
02.12.2008 Lycopodium 3 doses at She was advised not to discontinue treatment and to be patient for
1M five minutes some more time
interval
31.12.2008 Placebo BD Patient reports marked improvement in the swelling of thyroid.
Discharge from the right nipple has lessened.
06.02.2009 Placebo BD Improvement continues on symptomatological as well as pathological
parameters. Skin appears more clear.
12.02.2009 Placebo BD No visible swelling of Thyroid gland. No burning in palms and soles.
No anal itching. Discharges from right nipple disappeared.
The patient was advised to get USG of thyroid gland done.

Indian Journal of Research in Homoeopathy

Vol. 5, No. 2, April - June, 2011
44
[Downloaded free from http://www.ijrh.org on Thursday, August 19, 2021, IP: 14.139.55.162]

A Case of Colloidal Nodular Goiter

Bindu Sharma

USG (thyroid): Dated:12/2/09

Thyroid lobes and isthmus of the thyroid are normal in No gross evidence of any focal area of altered echo
size, shape and echo texture. texture seen. Report shows normal study. (Fig. 4)

(Fig. 4)

DISCUSSION On re interrogation it was found that an important rubric

‘Weeping when thanked’ was left out in the earlier
In modern medicine, colloidal nodular goiter repertorisation, although the symptom was present in
patients are often advised partial thyroidectomy which the patient since beginning. Also the rubric ‘Irritability’
was advised in this case too, since there is no specific was qualified by the patient as ‘Irritability, menses
treatment for such a disorder. In Homoeopathy, a before’, so it appears that in the initial repertorisation,
prescription is always based on holistic approach which incomplete totality led to selection of partial similimum
implies a totality of symptoms constituted by Mental which brought partial relief to the patient.
Generals, Physical Generals and Characteristic
symptoms of the patient. For building up this totality, Dr. Hahnemann advises us in § 213 Organon that
judicious case taking by thorough interrogation of “We shall, therefore, never be able to cure conformably
emotional and psychological factors like fears, grief, to nature – that is to say, homeopathically – if we do
shock, anger, suppressed emotions etc. must be taken not, in every case of disease, even in such as are
into account. acute, observe, along with the other symptoms, those
relating to the changes in the state of the mind and
Reference to literature revealed that in one case disposition, and if we do not select, for the patient’s
of Adenomatous goiter the size of the swelling reduced relief, from among the medicines a disease-force
in a short span of four months with Calcarea carb.5 which, in addition to the similarity of its other symptoms
Similarly 2 cases of goiter were reported successfully to those of the disease, is also capable of producing a
treated with Aurum muriaticum natronatum.6 similar state of the disposition and mind”.7

In this case, Sulphur was primarily selected as first If we retrospect the case we find that Lycopodium
prescription. Based on the totality of symptoms drawn was the similimum right from the beginning and when
from initial case taking, the medicine (Sulphur), acted it was prescribed in rising potencies from 30 to 1M the
partially giving only some relief to the patient and not result was total removal of Colloidal nodular goiter
curing her despite having given sufficient time to act. along with accompanying symptoms like Itching in

45 Indian Journal of Research in Homoeopathy

Vol. 5, No. 2, April - June, 2011
[Downloaded free from http://www.ijrh.org on Thursday, August 19, 2021, IP: 14.139.55.162]

A Case of Colloidal Nodular Goiter

Bindu Sharma

anus, burning of palms and soles, anxiety, milky person thus paving the way to correct repertorization
discharge from the right nipple etc. and final selection of the similimum.

The case also reflects relevance of analysis and ACKNOWLEDGEMENT

evaluation of the symptoms and teaches us how
The author is grateful to Dr. S. R. Sharma, former
repertory as a tool can lead us to a similimum or
Asstt. Director, In charge, RRI (H) Shimla, for extending
partially similar medicine. Sulphur played some role in all the technical and administrative support and editing
the patient and Lycopodium completed the cure. The this case report. The author acknowledges Dr. P. S.
pivot on which homoeopathic cures stand is the art of Chakravarty, Asstt. Director,CCRH, for his valuable
case taking and the evaluation and analysis of suggestions. I am also thankful to Dr. Pritha Mehra,
symptoms. It proved to be a classical cure, a rapid Research Officer (H), CCRH Hqrs, for helping in
gentle and permanent restoration of health, the conducting literature review for this case report.
removal of disease in its whole extent in the gentle,
harmless way on the principle of similia. REFERENCES

CONCLUSION 1. Paul A. Fitzgerald. Endocrine Disorders. Current Medical

Diagnosis and Treatment 2009, 48th Edition. Mc Graw
Hill. p.992.
The simillimum is the remedy that individualizes
the patient and such a remedy works at the deeper 2. B. R. Walker, A.D. Toft. Endocrine disease. Davidson’s
levels and leads to permanent restoration of health Principles and Practice of Medicine, 19 th Edition.
which is evident from this case. The patient improved Churchill Livingstone, p.703.
on all psychosomatic and pathological parameters. The 3. Synthesis repertory. Radar 7.1
thyroid nodule disappeared, milky discharge from right
nipple also stopped. There was not only improvement 4. Combined repertory. CARA Professional v.1.4
in her anxiety, weeping tendency and irritability but 5. Gupta Girish. A case of Adenomatous goiter. Homoeo
general appearance of the patient changed altogether. Times. Vol.4 (11), November 2007:25-27.

The correct approach for analysis and evaluation 6. Sevar Raymond. Aurum muriaticum natronatum – four
of symptoms needs to be followed to avoid errors in case reports. Homeopathy. (2007) 96:258-269.
arriving at the correct remedy. This case again proves 7. Hahnemann S. Aphorism 213. Organon of Medicine 5th
beyond doubt the importance of mental symptoms in edition. Swaran Publishing House, New Delhi.
evolving the individualized picture of the disease p.157.

Indian Journal of Research in Homoeopathy

Vol. 5, No. 2, April - June, 2011
46