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  The Thyroid-Part 2
  

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By: Matthias Girke
(Original title: Die Schilddruese n. Merkurstab 1995; 48: 564-83. English by A. R Meuss, HL, MTA.)

Two diseases of the thyroid
Hypothyroidism and hyperthyroidism
The image of the thyroid given in Part 1 essentially arose from contrasting euthyroid with hypothyroid metabolism. The changes seen with hyperthyroidism will be considered below, largely leaving aside the underlying condition of the thyroid for the moment.

Again, the system of limbs shall be our starting point. With hyperthyroid metabolism, one often sees reduced muscle strength and easy fatiguability, which may also involve atrophy of skeletal muscle.(1) The term "thyrotoxic myopathy" applies. The condition is accompanied by creatinuria, with reduced muscle creatine and phosphocreatine levels. The negative nitrogen balance seen with hyperthyroidism is said to be largely due to loss of protein from muscle. Increased rather than physiological activity is reported to limit the skeletal muscle organization and hence the instrument by which the soul reveals itself in developing external will activity.

What changes occur in bone? Bone resorption is increased and greatly in excess of osteogenesis.(11) Hydroxyproline elimination is elevated, suggesting collagen degradation. A negative calcium balance develops, with increased fecal and renal elimination. The calcium concentration in sweat is said to increase more than twofold." The negative calcium balance gives quantitative expression to loss of calcium quality from the organism, especially if we include elimination in sweat, and we get the image of a subtle calcium sphere surrounding the organism. This combines with powers of soul that are freeing themselves from the life organization and restlessly seek to come to awareness. A metamorphic relationship to oyster shell secretion with its spirit-releasing quality can be perceived.(48)

Powers of soul turning to excessive awareness go hand in hand with extensive catabolic processes in the metabolic sphere. Protein catabolism, ultimately preponderant, with the level of protein synthesis lower than this, characterizes the changes in protein metabolism. Hepatic glycogen stores are reduced.(23) Lipid deposits also decrease, and fatty tissue may be generally reduced. The predominantly catabolic increase in metabolism is combined with increased generation of warmth. Soul development oriented towards the sphere of conscious awareness struggles to arise as fire processes with increased oxygen consumption(23) take hold of the organism. Reference has already been made to changes in the fluid organism, with special emphasis on the blood quality which is in contrast to hypothyroid cumulation of extracellular fluid that in many respects may be compared to lymphedema. The circulation grows hyperdynamic, with increased heart rate, contractility, and often also hypertrophy. The increased heart rate shows only minor reduction in the sleep phase.(34) With its dynamic and warmth organization clearly increased, the blood turns specifically to the sphere of the senses, above all the skin. Hyperthyroid individuals have a warm skin and, among other things, erythema due to increased dermal circulation. Episodic flushing may occur in face and thorax. These skin areas tend to show teleangiectasis.(7) Cerebral circulation is also increased, which will be discussed later. An excited blood quality enters into the sphere of the neurosensory organization, with the soul life at the same time restlessly turning to waking consciousness. The whole is a metabolic process excited by the NSS, in marked contrast to the anabolic metabolic process in the sleeping human being.

The soul turns to waking consciousness, which becomes impressively apparent in the symptoms of hyperthyroidism. Waking consciousness turning to the surrounding world is greatly increased, frequently combining with sleeplessness. Soul activity is generally accelerated and may become marked restlessness. This dynamic is not experienced as a power belonging to the individual; patients with hyperthyroidism feel as though they have been taken hold of by an unknown dynamic that rises from the organism and breaks it down in catabolic processes. Differentiation is apparent between excessive astral activity and a quality of I organization that does not adequately guide and structure this activity. This differentiation is vital with hyperthyroidism.(52)

Endocrine opthalmopathy
Rudolf Steiner gave the exophthalmos, seen with Basedow's or Graves' disease, as a characteristic example of this imbalance.(52)

A brief look at the embryological development of the eye organization shows two gestures. First, the optic cup develops and the stalk carrying the hyaloid artery. We see the eye organization turning to the outside. On the other hand, a centripetal process of invagination starts from the placode, opening inward like a gulf. The direction of these gestures may be said to be reflected in exophthalmos and enophthalmos. Exophthalmos is seen in conjunction with endocrine ophthalmopathy such as the hyperthyroidism of Graves' disease. This shows numerous relationships to the sympathetic nervous system, whereas enophthalmos, combined with ptosis and meiosis, is part of Homer's syndrome, where sympathetic quality is reduced, and the parasympathetic nervous system predominates (Fig. 4).



Fig. 4. Exophthalmos and enophthalmos.

Looking for the connection with human soul and spirit nature, we can feel our way by characterizing the connection between sympathetic nervous system and waking-up process on one hand and parasympathetic system and sleeping human nature on the other, though this does not do full justice to the essential nature of the autonomic system. Pupillary reactions provide a telling example. We tend to concentrate on reactions to outside light and fail to realize that the size of the pupils also reflects reactions of the inner light of soul. Pupils enlarged with shock are as much part of the waking consciousness that goes with this as is sleep, when meiosis narrows the pupils, and external light also tends to be reduced. The light and soul qualities of lightness and darkness, or the soul's awakening or going to sleep, come to expression in pupillary reactions, again showing a connection between conscious life in the senses and sympathetic quality on one hand and the soul going to sleep, seeking its night-time constellation, with parasympathetic quality on the other. This difference in the soul's reactions is also apparent in the wide open palpebral fissure of hyperthyroidism and the drooping lid of a tired or sleeping eye.

The above can throw light on the exophthalmos seen with immunogenic thyropathies. Soul forces powerfully wanting to reach the waking state go hand in hand with the protruding eyeballs. Endocrine ophthalmopathy develops when astral activity is excited and not adequately guided and structured by the I organization (Fig. 5).

"The astral body pushes the eyes out. The I organization exists to control this. Our eyes are maintained in the position which corresponds to the organization by the both stable and unstable balance between I organization and astral body."(52)

Diffuse and nodular goiter
Focal and disseminated autonomy
Frequent use of the term "adolescent goiter" points to a major developmental period when the incidence of thyroid enlargement is increased. It is the time when the astral body is born in the human organism. If the astral body does not intervene sufficiently, letting the inner life of the soul come awake, vital forces predominate that generate new, proliferative thyroid follicles. The resulting thyroid enlargement is soft on palpation. Goiter occurring spontaneously and not only endemically thus points to a difference in the way the astral organization takes effect as the underlying change. This throws considerable light on endemic iodine deficiency which is today given so much weight in the pathogenesis. Iodine appears to have a special relationship to the astral body and be a tool used by that body.

If thyroid enlargement persists for some time, the organ may gradually harden and even develop nodular and pseudonodular structures. Nodular goiter develops largely in the second half of life; it is hard and nodular to the touch. Here sclerotic quality comes to realization in nodular space-occupying structures that are closed off in themselves like heads; it also causes circumscribed areas of calcification. The astral organization here assumes a head-like constellation. "Awakening" may come with this, with the different forms of autonomy developing as scintigraphically denser areas that may lead to decompensated hyperthyroid metabolism. Nodular proliferation processes are enhanced to the level of hyperthyroidism, with the inner awakening that goes with this.

Nodular changes in the thyroid, thus, reflect marking-off processes at different levels of the essential human being. At the level of physical organ structure, hard, sclerotic nodular forms evolve; part of the thyroid marked off in a head-like form. It arises with the help of etheric vital and proliferative processes that no longer serve regular growth but have separated out from the regular laws and order. Ultimately, this autonomy may develop and - if there is decompensation - the manifestly hyperthyroid metabolism that shows a distinct relationship to the sentient organization. This also separates out from the subtle functional regulatory process, forcing the organism to come increasingly awake. In the differentiated thyroid function with the rhythmic and circadian time configuration shown at the level of TSH,(54) a more rigid quality appears as autonomy evolves. If the limiting, head-related functional gesture takes hold of circumscribed areas in the thyroid organization, uni- or multi-nodular goiter develops. If it takes hold of the whole organ, disseminated autonomy results.

The current view is that a tendency to autonomy is inherent in the thyroid follicles. Thus, areas with autonomously-functioning cells may be found in "healthy" follicles. An unstable equilibrium clearly exists between the



Fig. 5. Pharmacologic sympathetic stimulation, right-sided. Palpebral fissure wide open, protrusion, mydriasis. From Hollwich(16), with kind permission.

ordering principle that governs thyroid function and makes it part of the functional whole of the organism on one hand and uncontrolled awakening of the sentient organization in conjunction with different forms of autonomy. This seems to point to interaction between astral and I organization, something which will later be discussed for another form of hyperthyroidism.

Nodular goiter may also be characterized from the point of view of the liver-thyroid-nervous system metamorphosis we have been considering. Similarly to the way the lung changes to emphysema if the head quality becomes predominant or the liver develops nodular cirrhosis, excessive activity of the neurosensory organization can lead to space-occupying nodular changes in the thyroid.

Summing up, comparison of the diffuse goiter seen in young people and the nodular goiter in the second half of life shows that the soul organization acts differently in the course of a person's life. m the time configuration of the thyroid, proliferative vitality in youth is in contrast to the sclerosis which even goes as far as circumscribed calcification in the nodular goiters of generally older people. Principles for treatment begin to emerge more clearly. With diffuse goiter, it will be a matter of strengthening the soul organization's influence on the organism. On the other hand, merely giving iodine or the suppressive hormone treatment, that was widely used in the past but has now largely been abandoned, forces the astral organization to act in the desired way, but the necessary activity does not develop in the thyroid itself. Recurrence of the goiter following discontinuation of the suppressive treatment with thyroxine shows that the method does not achieve a cure. Nodular goiter, on the other hand, demands treatment designed for a head-like constellation of the aspects of the human being that is developing in the wrong place.

Iodine and the thyroid
A look at the essential nature of iodine may help us to gain further insight into the development of goiter.

Iodine occurs in algae, often in considerable quantities. Courtois found it in seaweed ash in 1811. Algae, plants that do not develop flower nor root but develop mainly in the middle, leaf organization, grow in a vast variety of forms in the oceans. They are also found on moist leaves, bark and rocks and in other damp places. Their habitat may thus be said to be water touched by air and illumined to a variable degree by the light.(29) "Algae and fungi are plants wholly immersed in the interaction between air and the watery element."(51) Their almost unquenchable vitality still holds within it the dulled action of light. The relationship to light is also evident from the colors. Depending on light intensity, algae are blue, green, red or brown.(29) They take up CO2, and create their living bodies from this constituent of the airy element, with hard mineral deposits and trace elements, especially iodine, within this. The elements of light, which illumines the animal and the human soul in their different sensory modalities, and of air, which carries the sounds in which the inner life comes to expression, are here still wholly given to anabolic life, with consciousness dimmed. The vital organization of these plants has taken in the activities of air and light whilst still in a sleep-like state.

The language of substance expresses this gesture in the iodine taken in by the living organism. If, on the other hand, we consider the essential nature of iodine - greyish black crystals with metallic luster and acrid smell that evaporate in air (without going through a liquid phase), its actions decidedly against life (microbicidal) - it is hard to think of a greater contrast to the living world of the algae. Iodine cumulates in the human thyroid, which contains about a quarter of the body's total iodine concentration, in the salivary glands, gastric mucosa, breasts and placenta. The antimicrobial quality of iodine can also be found in the thyroid organization, which absorbs this element so strongly, for the gland is highly resistant to abscess formation, even if bacteria are injected directly into it.

We can see that in an ensouled organism iodine becomes part of the soul organization's sphere of action; its connection with the thyroid shows this most clearly. With air and light, iodine is also part of the living algal organism which has not yet awakened to become an instrument of the soul. Considering the substance quality of iodine we see a metamorphosis similar to that seen in the transition from aquatic creature to air-breathing life form. In algae, iodine - comparable to a soul that still sleeps - is taken into the sphere of life. In thyroid metabolism, it serves soul life as it comes awake. In the thyroidal colloid, bound to the proteinic quality of thyroglobulin, we get an image comparable to the algal state. As an iodine-containing hormone, it serves the waking soul, though now released from the protein bond. Here, we perceive one characteristic that may prove useful for our approach to treatment: "algae... will be used if physical body and ether body refuse to let the astral body come in, with disharmony arising because resistance comes from the ether body; where the I organization is not the dominant principle, and the specific resistance comes from the ether body."(51)

Graves' disease - Hashimoto's thyroiditis - primary myxedema Basedow's or Graves' disease belongs to the group of immunogenic thyropathies which will be discussed in more detail below. Here, too, the significance of the human psychic organization is clearly evident. Graves' disease may, for instance, manifest after severe mental shock. Devastating destiny events and separation from their nearest and dearest may initiate soul dynamics in people with the appropriate physical constitution that cannot always be got under control by the individual. It is significant that the age when Graves' disease manifests peaks in the twenties and thirties. At this time the I organization, which takes effect from the fourth 7-year period onwards, creates the differentiated configuration of sentient soul, intellectual soul and spiritual soul. Similar to the way diffuse goiter presents an image of inadequate astral activity. Graves' disease presents as pathology of the process in which the individual nature of a person is "born," starting from the 4th year of life. The disease may, of course, also manifest outside this period, e.g. in neonates, young children or old people. But its true nature emerges as an awakening astral organization lacking adequate guidance and direction from the I organization. What is the symptomatology of the syndrome, and how does it relate to autoimmune Hashimoto's thyroiditis and primary myxedema?
With Graves' disease, we have intense, extreme development of the inner awakening seen with a normal thyroid. Vital energies turn into powers of conscious awareness that flare up restlessly, leaving the organism to eat itself up in catabolic metabolism. The astral organization is oriented towards the day side, the neurosensory organization. As already shown, the blood quality enters into the sphere of the senses. The supply of blood to the skin is several times the normal level, and the hemodynamic of the nervous system is also enhanced, though the opposite was thought to be the case in the past. Compared to hypothyroidism with its reduced cerebral blood flow, we see enhanced flow and increased oxygen utilization in a hyperthyroid organism.(1) The soul, struggling to attain conscious awareness, is unable to have a calm life of thought, and we hear of the hectic unrest that drives and torments these patients. We see a soul organization that cannot be adequately guided and structured by the I organization.

Hashimoto's lymphocytic thyroiditis is closely related to Graves' disease.(56) Some patients with a history of Graves' disease actually show the antibody constellation of autoimmune thyroiditis. This "transition" from Graves' disease to lymphocytic thyroiditis is known.(25,56,57)

Conversely, marked hypothyroidism with a background of Hashimoto's thyroiditis may occasionally be followed by hyperthyroidism taking the form of Graves' disease. In fact, the two conditions may coexist in one and the same thyroid,(57) e.g. as "Hashi-toxicosis." A metamorphic relationship of the two conditions suggests itself. Hashimoto's thyroiditis involves enlargement of the thyroid, whereas the atrophic form shows regression and diminution of the organ. It appears that this thyroid disease can develop from an auto-immune thyroiditis, including the Hashimoto form. The classical Hashimoto is chronic lymphocytic thyroiditis with thyroid enlargement. The atrophic form, often called primary myxedema, appears to be on the other side of the spectrum. In any case, it is clearly justifiable today to speak of immunogenic thyroiditis involving either enlargement or atrophy of the thyroid. This is in contradistinction to earlier assumptions of distinct disease entities (Doniach).

It thus appears that the spectrum, beginning with Graves' disease and seeking connection with autoimmune thyroiditis, extends as far as the atrophic form of thyroiditis.
In terms of pathological processes. Graves' disease involves an excessive increase in metabolism, with a massive increase in blood supply, as demonstrable by Doppler ultrasound. This emphasis on the metabolic system is also evident in the thrill perceived above the thyroid on auscultation that was more commonly noted in the past.
With Hashimoto's thyroiditis, on the other hand, one sees a different orientation. This a chronic lymphocytic thyroiditis with increasing connective tissue involvement and marked fibrotic changes in some parts. At the advanced stage hardly any healthy parenchyma is found among the extensive fibrotic changes in connective tissue.(27) Similar changes may finally characterize the atrophic form of thyroiditis. Compared to the emphasis on the metabolic system with florid Graves' hyperthyroidism, evolution of the disease spectrum shows progressive sclerosis with the result that the qualities of the neurosensory system become unphysiological in their effects.

The sclerotic process is also demonstrable in other diseases associated with autoimmune thyroiditis. Thus, Hashimoto's thyroiditis has a connection with Sjoegren's syndrome,(56) and also with the sclerotic changes in Diabetes Mellitus. Hypothyroidism also has a connection with coronary disease, which tends to be more marked, and with reduced HDL serum cholesterol.

To my mind, it is important to know that thyroid lymphoma and papillary carcinoma of the thyroid are reported to show a rising incidence in the evolution of lymphocytic thyroiditis.(24) It is no doubt too early to call it a precancerous condition, but it may be an instance of the relationship between chronic inflammation and malignancy that has been mentioned a number of times. Interestingly enough, patients with papillary carcinoma of the thyroid and thyroiditis are said to have a better prognosis than patients with papillary carcinoma and no inflammatory changes. The different qualities of the two types of inflammation, acute and chronic, are reflected in this observation.

At the level of pathological processes, a polarity emerges between a syndrome where the emphasis is on metabolism, with increased blood supply, and thyroid disease characterized by progressive connective tissue sclerosis.

Considering the functional aspect of thyroid metabolism, the given sequence of thyroid diseases contrasts the hyperthyroidism of Graves' disease with the hypothyroidism of primary myxedema. Autoimmune thyroiditis again has a middle position, frequently beginning with hyperthyroid metabolism and later developing latent hypothyroidism.
Let us consider how the soul life connected with these diseases may be characterized as we progress from pathological process to soul organization.
Autoimmune thyroiditis is often connected with a lively, agitated inner life, its accompanying restlessness showing similarity to Graves' disease. Elevation of basal TSH and consequently latent hypothyroidism create a marked contrast between subjective and objective findings. In contrast to Graves' disease, one does not see the metabolic changes characteristic of hyperthyroidism. The life of the soul often seems to receive little guidance from the I organization but does not take hold more intensely of metabolism, as with the hyperthyroidism frequently seen initially nor with Graves' disease. The astral body turns more from metabolic activity to the sphere of consciousness, presenting as a wide-awake and restless inner life.

The partial withdrawal of metabolic life in the soul organization may ultimately lead to inadequate metamorphosis of vital forces and powers of consciousness, giving rise to the clinical syndrome of hypothyroidism. Initially, one is inclined to assume reduction of conscious awareness to a sleep-like level because patients tend to sleep more. Yet the refreshing, strengthening aspect of sleep has a completely different quality and should not be confused with the hypothyroidism which now develops, evolving a definitive disease type that shows many sclerotic tendencies. Rudolf Steiner drew attention to the polar opposite qualities of sleep, its health-giving and, on the other hand, its morbific, sclerosing effect.(52) At the soul level, people suffering from hypothyroidism present an increasingly rigid, dull, indifferent waking state, with decreasing interest in the environment. In connection with hyperthyroidism and the hypothyroidism manifesting at the opposite extreme of me pathological spectrum under consideration, we thus see two opposite soul gestures.

Dynamic and sclerosing soul life
Comparing the two syndromes in the group of immunogenic thyropathies we perceive the different ways in which the astral organization works. Graves' disease involves extreme activation of metabolism in terms of a life-



Fig. 6. Graves' disease - autoimmune thyroiditis - atrophic thryroiditis in relation to the threefold human organism.

consuming catabolism and increased powers of conscious awareness. With Hashimoto's thyroiditis, this trend is reduced; one quite often sees an agitated inner life but not the kind of marked metabolic activity that may ultimately lead to hypothyroid limitation of conscious awareness.

Considering these evolving contrasts, it is important to turn our attention to the fundamental factors that create the state of waking consciousness. Rudolf Steiner said the following with regard to evolution of the world of thought:
Thoughts would never flash through the soul if the actions of the I and the astral body did not combine, which comes to expression in the interaction between blood and nervous system. Human scientists of the future will find it strange that in present-day science the origin of thought is believed to lie entirely in the nervous system. The origin of thought does not lie in the nerves only. We have to realize that the process that gives rise to thought lies in the living interplay between blood and nervous system.

He then evolved the macrocosmic image that lies behind the genesis of thought:
When the blood, our inner fire, and the nervous system, our inner air, work together in this way, thought flashes through the soul. The genesis of thought in the inmost soul has its cosmic equivalent in rolling thunder. When the fire of lightning ignites in the air masses, when fire and air between them generate thunder, this is the macrocosmic event corresponding to the process in which the fire of the blood and the play of the nervous system discharge in thunder within us, though the sound becomes thought; it is gentle and calm, imperceptible to the outside world.(40)

Powers of thought, powers of conscious awareness are released from the organization in the catabolic process that goes with all conscious awareness as it develops and presents itself enveloped in the warmth and quantitatively-emphasized blood flow of the head organization. They shine out from the structural quality of the nervous system as "preconscious" powers to become conscious thought.

It appears that the "blood pole" of thinking is increasingly withdrawn with hypothyroidism, and the principle which in hyperthyroidism irrupts with increasing power into conscious awareness is increasingly silenced.

Rudolf Steiner put it like this:
If you read medical books today, it sounds as if the human being is going out of his mind with disease or absence of the thyroid. But no, he merely loses interest, growing dull, and does not use his mind. The mind is still intact when you're not interested. What is lost is the lively interest one has in things, the inclination to turn one's attention to things. Someone who has lost interest does not turn his attention to anything because he lacks the instrument. We do not give him a mind with the thyroid, but an instrument that enables him to take a lively interest in the things of the world.(41)

Here, our attention is unmistakably drawn, in connection with the thyroid, to the active, will-related aspect of the inner life in soul and spirit, to the development of active interest and attentiveness, and to an interest in the things of the world.

From this point of view, considerable light is thrown on the hypothyroid reduction in the level of conscious awareness, and on some syndromes involving dementia. One often sees an inner life that lacks involvement, is growing rigid, yet is wide awake, the blood-related dynamic of the inner powers having been lost. Apart from reduced interest in the environment, patients with manifest hypothyroidism often also show reduced speech activity,(2) and the generation of thoughts slows down. A sclerotic, hardened quality has arisen that may come to expression in many of the phenomena that have been described, and even in actual sclerosis.

Summing up, the thyroid diseases under discussion lie in the polarity of neurosensory system and system of metabolism and limbs. Going beyond the description of pathological processes they also show corresponding differentiation in the sphere of inner soul activity.

Therapeutic aspects
The above pathology of thyroid disease may be used to develop therapeutic aspects, only the major aspects of which will, of course, be considered. This gives the pathology its true significance in our medical approach.

Every human illness calls for healing at several levels, with different emphasis. The physical manifestation of the disease is usually treated by thyrostasis in the case of hyperthyroidism and substitution in that of hypothyroidism. Such an approach pays no attention to the other aspects of thyroid disease. How can we treat the pathological process that is reflected, for instance, in the spectrum of inflammation-related or sclerosing processes? How do we face the characteristic changes in soul life? What inner, individual challenge presents, so that the illness may lead to a further step forward in individual development?

Medical treatment - copper and iron
Major lines of approach can arise from consideration of the two functional gestures described in this paper, gestures characteristic of hyper- and hypo-thyroid metabolism. This does, of course, call for the status quo to be established. Many years of work with thyroid patients have resulted in specific approaches based on our perception of the disease. With patients who asked for anthroposophic treatment, we would sometimes see remarkable evolutions. Validation is still outstanding.

To begin with, we may recall the metamorphosis connected with thyroid activity. Gill breathing in water became the breathing of air, and in the sphere of the senses breathing in the light. If we think less in terms of larval metamorphosis and more of the different spheres of life and the life forms that belong to them, a relevant polarity may emerge. Marine molluscs, shellfish and snails, fresh water snails and even those that live on land, crayfish and octopus breathe with the aid of the pigment hemocyanin, which contains copper. They do not have their own definitive warmth organization; wrapped in a dim, voiceless life of soul they develop a soft body, secreting the hardening principle to the outside, e.g. in a snail shell. When the airy element is conquered, another metal - iron - becomes important. Its special function can be seen to consist in bringing the soul and spirit levels of existence into the living organism. Individual warmth, air breathing, and a soul quality that makes itself known in sound are able to develop. Every iron deficiency anemia with its inner lack of dynamic can evoke a clear image in contrast to the iron quality that brings spirit and soul into the organism.

In the neurosensory system with its abundance of arterial blood, phylogenetically developing early as the circulation becomes arterial, iron bears the dynamic qualities of conscious life. In the rhythmically moving blood it turns to the breathing process. In the system of metabolism and limbs it finds its place in energy and warmth processes. In the metabolic process of the respiratory chain, where remarkably large amounts of free energy are produced, it is an indispensable metal which here seeks connection with phosphorus.

The language of the phenomenology thus presents a contrast between two substances, with copper pointing to the night sphere of soul life and iron activity developing the emergent gifts of the soul.

Copper and iron present many qualities. Here a phenomenon is of interest that draws our attention to the pathological processes.

The vital processes of increasing warmth and elimination are very noticeable in acute inflammation. Added to this is an extensive vital respiratory process. We see this in the steep increase in oxygen uptake known as a "respiratory burst."(60) Oxygen quality is crucial in the process since microbicidal properties are reported to depend on oxygen. Oxygen relates to iron, which throws light on the metal's importance in acute inflammatory processes. This is given special significance here, leaving aside the other aspect of iron activity which can be shown to relate to the healing phase of inflammation.

The acute, destructive inflammatory process is met by a number of limiting metabolic processes involving different enzymatic functions that protect cells from the destructive metabolism of activated oxygen compounds. These include superoxide dismutase (SOD): "In the mammalian extracellular environment, extracellular SOD (ECSOD) and ceruloplasmin serve as antioxidant enzymes."(60)

SOD contains copper, ceruloplasmin is the copper-containing serum protein. Iron and copper are again at opposite poles, with iron relating specifically to acute inflammatory processes, and copper to catabolism of oxygen radicals, thus guiding the metabolic process towards the healing, constructive phase of inflammation, its "night side." We get an image of the polarity between the two metals that compares with what has gone before. Again, it is important to see that this point of view brings out specific features in the whole picture presented by these metals.

I would like to show how the metal qualities can be related to a soul life that is waking up, taking hold of the organism, on one hand, and a soul life that goes to sleep, calms down, on the other, and how they can gain clinical significance with hypo- and hyperthyroid disease.

Rudolf Steiner referred to chalcocite (chalcosine, copper glance) and cuprite as major medicines for Graves' disease. Chalcosine, a compound of copper and sulfur, shows a metallic luster on fresh surfaces; otherwise it is a dark leaden grey, usually with a black tinge. Beautiful crystalline forms with orthorhombic or hexagonal structure may occasionally arise. Cuprite (chaicotrichite) may be a deep red, and colors a flame green in the polar phenom-



Fig. 7. Cuprite octahedron on calcite; light-related precious stone quality of copper as "warmth metal" (with kind permission of Weleda).

enon. Its crystals are octahedral and rhombdodecahed-ral, less frequently cubic. The ordering, form-giving crystalline configuration is added to the calming quality of this copper oxide, which brings the inner life out of its state of excitation; a form-giving principle which is the opposite of the effervescent inner life we see in hyperthyroidism, strengthening the configuring powers of the I organization so that they may bring healing. Rudolf Steiner described chalcocite as follows:

I have shown you how chalcocite acts on the I organization. I have shown you what has to be considered in Graves' disease, so that we may say: if one is able to see the human being on one hand, with physical, etheric, astral body and I alive and interactive in it and see how this becomes abnormal in pathology, we also gain a clear view of what is to be found in the world of nature outside. Thus, one may have direct perception of the following: the I organization is too weak in Graves' disease. Outside I see chalcocite. Brought together with the I organization, chalcocite will considerably strengthen that organization:'(2)(Fig. 7).
The excited state of the inner life in someone with hyperthyroidism can be corrected by giving phosphorus. Rudolf Steiner differentiated between three routes: oral exhibition for metabolic hyperactivity, subcutaneous injection if excitation of the rhythmic system is a major element (tachycardia, tachypnea), and occasionally also baths as an external application if thought life is flitting, restless, with flight of ideas.(52)

Excitation of astral activity, with the astral organization "frozen" in its orientation on consciousness and no longer able to swing back adequately to its night constellation, can be relieved with iodine in high potency. In low potency in an algal preparation, for instance, iodine prepares the way for astral intervention; in higher potencies it can relieve excessive astral activity. Combination with an equally potentized organ preparation of the thyroid (Glandula thyroidea 20x, amp. Wala) has proved useful here. In this potency, the material realm is left well behind. The spiritual structuring power belonging to the thyroid is mediated, preparing the way for other therapeutic approaches. This may be said to be a special quality seen in anthroposophic medicine, for it is a matter not only of looking for medicinal agents from the world of nature that surrounds the human being, but of taking care to see how this may reach the "site" of its medicinal action. Thus, the essential image of lead is seen as a healing response to sclerosing processes. Its substance quality needs to be metamorphosed, however, before it becomes a truly medicinal agent in the form of Scleron, for instance.

Both chalcocite and iodine involve the higher levels of human nature in the therapeutic process. The metallic nature and form-giving qualities of chalcocite relate to the I organization through their form-giving quality, strengthening its activity relative to an excited astral activity. The above-mentioned copper qualities take excessively awake inner nature back into calming night activity. Potentized iodine is able to relieve astral activity pushing too strongly to gain a waking state.

Colchicum is another important medicine; it literally shows the connection between astral activity with the vital organization. Graves' hyperthyroidism and circumscribed, multifocal or disseminated areas of thyroid autonomy cause intense metabolic processes revealed by Doppler ultrasound in the form of enhanced blood flow, and in a scintiscan as increased uptake. Apart from increased astral activity, the thyroid and in the case of hyper-thyroid metabolism also the whole organism are found to be affected by vital warming processes, increased tissue respiration, and secretion. These enhanced metabolic processes, which with Graves' disease also take the form of inflammation-type infiltration of the organ, can be limited by giving Colchicum in low potencies. Colchicum treatment was suggested by Walbraum (personal communication, publication planned) and has proved effective on various occasions (F. Husemann, personal communication).

Form-giving restoration of the astral organization may be supported by Bryophyllum, also in conjunction with the consolidating Conchae process, opposing the powerful separating out of bone quality which combines with the restlessly flickering soul life of hyperthyroidism and is reflected in a negative calcium balance.

Another useful medicinal plant is gipsywort, Lycopus virginicus or, in Europe, Lycopus europaeus, a member of the mint family (Labiatae). This family relates intensely to warmth in many respects.29 In Mediterranean regions, where the sun is really hot, they take warmth into their organization in the substance language of volatile oils. This relationship to warmth often comes remarkably close to the soul sphere, something we become aware of, for instance, when walking through a field of flowering lavender visited by innumerable bees. Gipsywort produces less volatile oil than members of the family that relate more strongly to warmth. It relates less intensely to warmth and seems to turn away from it, growing in wet habitats, damp meadows, along ditches and bodies of water, seeking out the element of water. This gesture appears to determine its medicinal quality, for gipsywort is able to correct the excited soul activity that develops in conjunction with hyper-thyroid metabolism. As one would expect from the image that has been called up, the aerial parts of the plant are harvested just before it flowers.  The medicinal agents we have discussed provide the qualities we need: increasing I organization activity, therapeutic reduction of excessive astral organization activity, guiding it back from being predominantly oriented in consciousness to its physiological metabolic activity.

This throws additional light on conventional thyrostatic medication using thiourea derivatives. It appears that this developed from the observation, made in times of shortage, that cabbage is a goitrogen (brassica goiter). This natural relationship led to the development of thyrostatic drugs. It is thought that iodine uptake in the thyroid is inhibited because thiocyanate ions compete with the iodide. Rhodanide (thiocyanate salt or ester) ions are produced by degradation of mustard oil glycosides. The mustard oils created in this metabolic process may also yield vinyl-2-oxazolidine thione (goitrin) with thyrostatic activity. The two principles are not used as thyrostatics, but goitrins show structural similarity with carbimazole, for instance.(58)

Cabbage (Brassica oleracea)11 has tremendous vitality. The high water content (c. 90%) shows that the etheric sphere is highly developed. Clinical uses, e. g. in the treatment of wounds and local treatment of leg ulcers and bedsores, where the effects are immediately obvious, reveal a power to stimulate regeneration. In hyperthyroidism, powerful development of the life sphere sets limits to an astral organization that is restlessly seeking to attain conscious awareness. Personal experience to date has shown that this thyrostatic approach will be mainly required for a markedly hyperthyroid metabolism.
Apart from seeking to achieve a euthyroid state, it will be important to ask to what extent the anthroposophic clinical approach can guide the evolution. The factors that determine remission with Graves' disease or cause autoimmune thyroiditis to follow in the time configuration of the disease, are largely unknown. Many questions - for instance, those concerning the possible significance of the cuprite therapy mentioned by Rudolf Steiner - call for further research.

After control of the metabolic situation and outstanding research into the time configuration of the disease, the next level concerns the typical sentient configuration of thyroid diseases. This often does not strictly correlate with laboratory findings. Patients with Graves' disease and well-"adjusted" metabolism may continue to complain of "hyperthyroid symptoms"; others may have such symptoms when clinically they are actually hypothyroid, with autoimmune thyroiditis. This is a level where much good can be done, also for patients who had to be given thyrostatic drugs.

With hypothyroid metabolism, the approach to treatment has to be the opposite. Support needs to be given to a soul organization lacking in activity. Here, one may think of using the Levico Water complex. Its iron quality can help to gain the necessary orientation in soul and spirit that makes it possible to take hold of the organism. The arsenic content is also important. The essential nature of arsenic shows correspondences with the waking up process in humans.(49) The thyroid is said to have particularly high arsenic levels.(55) In terms of the substance language of Ferrum and Arsenicum, this medicament, often recommended by Rudolf Steiner, offers a particularly powerful means of energizing the astral body in many pathological situations. It may be used in conjunction with Hypericum, a plant where the quality of oil as a condensed warmth body(29) is taken into the middle region of the plant, the leaf sphere. Warmth that almost has soul qualities is taken into the vital organization of this plant, which is the therapeutic gesture our hypothyroid patients need. Prunus is another important plant (v. i.).

Such a therapeutic approach can prove particularly helpful with latent hypothyroidism. Severe, manifest hypothyroidism, e.g. with autoimmune thyroiditis, requires substitution treatment in addition.

Goiter and Colchicum autumnale
Colchicum autumnale may prove helpful in the treatment of diffuse goiter. This plant, which flowers "out of time," has a powerful flowering, the signature of astral activity. This suppresses vitality in the plant and prevents major leaf development, at the same time producing colchicine, a potent mitotic poison. The essential nature of diffuse goiter has been outlined above, with the astral organization unable to take adequate effect. This medicinal plant presents the therapeutic response: we have found that Colchicum autumnale has a powerful stimulant effect on the astral body, specifically the part that relates to the organization of neck and head.(38)

Where Colchicum treatment is too powerful, paralyzing activity, Prunus spinosa will vitalize. Functional efficacy of the astral body in the metabolic system may also be supported with Chelidonium, which has proved useful in this area in both topical and oral application.

The essential nature of iron, outlined above, helps us understand why topical application of Ferrum has given positive results with goiter patients.(32)

In this context, Rudolf Steiner's suggestion that thyroid enlargement may be met with "song-like speech"(53) is revealing and worth further investigation. The activity of the immediately adjacent larynx "resounds" through the vital processes active in goiter development. The soul quality of that activity transforms and limits the proliferative vitality coming to expression here.

Eurythmy therapy and inner work (v. i.) will give astral activity the necessary orientation. Exhibition of iodine in material doses, a method still widely used today and certainly indicated on occasion, does not cure; it merely forces the astral organization from outside to act as it should and does not give the necessary inner impulses. This is an area which also includes the different iodine-induced thyropathies. If we succeed in giving the higher aspects of human nature the right inward orientation with our treatment, it is often remarkable to see the positive effect, with the patient's inner life strengthened and consolidated. At a time when thyroid volume is determined by ultrasound, which is also used to monitor evolution under treatment, attention has been limited and reduced to the physical manifestation of the disease, progressively excluding the different sentient configuration seen with the disease. It is therefore important to remember this level of human nature even with diseases as undramatic as thyroid enlargement.

Eurythmy therapy
Eurythmy therapy seems indispensable in the treatment of thyroid disease. With reference to Graves' disease, Rudolf Steiner spoke of "appropriate consonantal movement."(49) In the LMS sequence L and M,with their relation to breathing, are followed by S. This brings its fiery, dynamic nature to experience in eurythmy as well as time powers of configuration and form.(18) The sound gesture directly reveals the form impulse needed to counter the untrammeled dynamic of florid Graves' disease. "Form" and "fire" come together in this consonant.

Collaboration between eurythmy therapist and physician can be
particularly fruitful in this field. The author has gained many valuable suggestions and points of view from such collaboration. The frequently-mentioned problem of a "common language" also finds an immediate, evident solution, for the essential nature of Graves' disease leads directly to the necessary treatment, also found in the substance language of cuprite, for instance, and - most impressively when one sees it-in the "S" of eurythmy therapy.

The double nature of the "S" may point the way to treatment of hypothyroidism. The essential nature of this condition - in severe cases marked by soul life becoming increasingly rigid, and involving many phenomena relating to an organism that is also growing rigid, with a tendency to sclerosis, having lost its warmth - can sometimes be met with the "fire quality" of the "S." If the dynamic configuration comes close to that of Graves' disease, that "fire quality" seems to develop a relationship to hypothyroidism.

The disease spectrum with its metamorphoses ranging from Graves' hyperthyroidism on one hand and hypothyroidism developed on the basis of autoimmune thyroiditis on the other, comes together, as it were, in this one element of eurythmy therapy, the "form" and the "fire" of the "S." This may also help us understand why the SMLA sequence, (apparently) one and the same, and recommended for hyper- and hypothyroidism, includes the "S."(18)

Inner work to be done
With hyperthyroidism, soul powers push restlessly towards conscious awareness. They need to be given form and configuration by the individuality. Initially, this requires mainly medical treatment, to get the I organization sufficiently active. Eurythmy therapy will effectively complement this, with consonant quality taking up the form-giving principle we have already met in the crystalline form of cuprite. A disease like this does, however, clearly ask for inner work to be done. The individuality must gain sovereign control as the charioteer who masters the dynamic of his horses which have gone "out of control." At the inmost level, entirely within the individual's own sphere of activity, we see for the third time the need for a guiding, configuring principle. The individuality must find a way of maintaining itself within powerful soul dynamics.

The situation is very different with the rigidifying, increasingly disinterested inner life lacking in drive we see in hypothyroid patients. Here, we have to find the medicinal gesture described above as an inner task, calling on the patient to take an active part in the process of recovery. Warmth and the will power of the individuality must flow again into an inner life that threatens to grow rigid.

The emotional instability seen with some forms of latent hypothyroidism unmistakably indicates that the inner task is to become "measure and master in the ebb and flow of feelings." The phrase, taken from Christian Morgenstem's poem below, points to the central significance of the "six qualities" for this pathological spectrum. In each of the fields requiring schooling - thinking, feeling and will intent - we also meet the opposite nature of an inner life driven by different dynamics, e.g. uncontrolled, associative thinking, and the rigidifying, sclerosing quality that does not allow new thoughts to evolve when a concentration exercise is done for an extended period. It will be important to practice the exercises with the patient, starting with a general description and taking them directly into the sphere of life, with the necessary inner work given the appropriate emphasis in each situation:

No longer creature, controller of one's thoughts, lord of one's will, no longer slave to it, measure and master in the ebb and flow of feelings, too deep to fall into negation, too free and open to be obdurate; thus man being may bind himself to realm of spirits and find his way up to the throne of thrones.(26)

If treatment uses such an approach with its many levels, the disease may bear significant fruit, helping the individual to develop. The quality of light inherent in the disease begins to emerge from the shadows.

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