|Year : 2021 | Volume
| Issue : 3 | Page : 206-212
Efficacy of ayurveda treatment modalities in the management of hypothyroidism: a case report
Jitendra Varsakiya1, Divyarani Kathad2, Ritu Kumari3
1 Department of Kayachikitsa, Ch. Brahm Prakash Ayurveda Charak Sansthan, Khera Dabar, Najafgarh, New Delhi, India
2 Department of Shalakya Tantra, Akhandanand Ayurved College, Ahmedabad, India
3 PG Department of Kayachikitsa, Ch. Brahm Prakash Ayurveda Charak Sansthan, Khera Dabar, Najafgarh, New Delhi, India
|Date of Submission||23-Apr-2021|
|Date of Decision||24-Jul-2021|
|Date of Acceptance||25-Jul-2021|
|Date of Web Publication||28-Sep-2021|
Dr. Jitendra Varsakiya
PG Department of Kayachikitsa, Ch. Brahm Prakash Ayurveda Charak Sansthan, Khera Dabar Najafgarh, New Delhi.
Source of Support: None, Conflict of Interest: None
Hypothyroidism is a metabolic disorder resulting from insufficient synthesis of thyroid hormones, which are one of the key factors for the maintenance of metabolism. India has a high prevalence of hypothyroidism, which is about 9.4% subclinical cases, and this is more common in females than males. In Ayurveda classics, the functions of metabolism depend on Agnimandhya (weak digestive fire), mainly Medo Dhatwagni Mandya (decreased metabolic factors located in fat tissues). The normal metabolism of tissues is achieved by the management of Agni. A case of hypothyroidism was treated with bio-cleansing therapy, which included Virechan Karma (therapeutic purgation) along with oral medication Kanchnaar Guggulu with Varunadi Kashaya on an empty stomach. The result was assessed on the basis of the level of thyroid stimulating hormone (TSH) and the improvement in the general condition of the patient. The level of TSH decreases from 64.4 µIU/mL to 2.65 µIU/mL during the duration of six months, with an overall subjective perception of feeling well. The present case study demonstrates that hypothyroidism can be managed by the Ayurveda treatment modality.
Keywords: Agnimandya, hypothyroidism, metabolism, Virechana Karma
|How to cite this article:|
Varsakiya J, Kathad D, Kumari R. Efficacy of ayurveda treatment modalities in the management of hypothyroidism: a case report. J Indian Sys Medicine 2021;9:206-12
|How to cite this URL:|
Varsakiya J, Kathad D, Kumari R. Efficacy of ayurveda treatment modalities in the management of hypothyroidism: a case report. J Indian Sys Medicine [serial online] 2021 [cited 2021 Dec 4];9:206-12. Available from: https://www.joinsysmed.com/text.asp?2021/9/3/206/326838
| Introduction|| |
In today’s scenario, due to the sedentary lifestyle and stress alterations in the activities of the neuroendocrine system cause newer health challenges such as hormonal imbalance, which leads to disorders such as hypothyroidism. Hypothyroidism is a disorder that occurs when the thyroid gland does not make enough thyroid hormones to meet the body’s need. The thyroid hormone regulates metabolism—the way the body uses energy—and affects nearly every organ in the body. Without enough thyroid hormone, many of the body’s functions slow down. Hypothyroidism is a disorder of the thyroid gland and its prevalence in the developed world is about 4%–5%. The prevalence of subclinical hypothyroidism is about 4%–15%. It is estimated that about 42 million people suffer from thyroid disorders in India. Women are six times more prone than men to suffer from thyroid disorders.,
According to the Ayurveda point of view of hypothyroidism, there is abnormality of Jatharagni (factors located in the digestive tract) and Dhatwagni (metabolic factors located in Dhatu) along with an abnormality of Kapha (dosha responsible for regulating body fluids and keeping the body constituents cohesive), Vata Dosha (Doṣha responsible for movement and cognition), Rasavaha (channels carrying nutrient fluids), Raktavaha (channels carrying blood tissue), Medovaha (channels carrying fat tissue), Shukravaha (channels carrying reproductive tissue), and Manovaha Srotas., Due to Medo-Dhatwagnimandya (decreased metabolic factors located in fat tissues), the production of abnormal fat tissues occurs. This vitiated fat tissue that accumulates in the body leads to an increase in body weight. This sign also indicates the derangement of channels carrying nutrient fluids and increased Kapha Dhatu in the body. Hence, according to Ayurveda principles, by treating the Agni (digestive factors), the metabolism of the body can be managed, ultimately dealing with conditions such as hypothyroidism.
| Case Report|| |
A female patient aged about 45 years old presented in the OPD with complaints of loss of strength, constipation, unexplained weight gain, heaviness in the body, improper digestion, fatigability, generalized debility, and diminution of digestion. Two years earlier, the patient had a gradual onset of weight gain with a complaint of cold sensitivity and disturbed bowel movement. After a few months of this, she developed generalized body ache, hoarseness of voice, and lethargy. Gradually, she developed loss of strength, hair loss, and constipation. Initially, she had started taking thyroxin hormone in a dose of 75 mcg per day but her general condition did not improve nor did the level of TSH decrease.
| Case Findings|| |
On examination of the patient, her pulse rate was 72/min, with BP 110/70 mmHg. Bowel history was once in two to three days with hard stools and a frequency of micturition three to four times/day, one to two times at night. The patient’s appetite was poor. Her tongue was not clear. The patient had disturbed sleep due to muscle pain and stiffness. She complained of stress or emotional disturbance also. The patient was generally anxious, lethargic, and slow in terms of activity.
Diagnostic Focus and Assessment
The best laboratory assessment of thyroid function, and the preferred test for diagnosing primary hypothyroidism, is a serum TSH test. The diagnosis of hypothyroidism was made on the basis of derangement of the thyroid function test in which the level of TSH was increased and on the basis of complaints of the patient.
| Treatment Plan|| |
After complete examination was done with Ayurveda Aspects and after assessing strength, humors, body constitution, age, psychological strength and digestive capacity, Patient was asked to admission in IPD for the administration of bio-cleansing therapy. It was planned for the patient to undergo Virechana Karma (therapeutic purgation).
Before the administration of medications, bio-cleansing was done to clear the channels for the better efficacy of medications. For that purpose, Virechana Karma (~therapeutic purgation) was done in November 2018 [Table 1]. The patient was given 2 g powder of Haritaki (Terminalia chebula Retz.) and 2 g powder of Shunthi (Zingiber officinale Roscoe.) with lukewarm water before the meal twice a day and Triphala Churna in a dose of 5 g with lukewarm water at nighttime for enhancing metabolic functions and enhancing digestion. After five days, the patient reported improvement as her bowel habits became clear and regular, her diet and hunger was improved, and she was feeling lightness in her body; then, Mahatriphala Ghritata for therapeutic internal oleation for five days in an increasing dose (of 30, 60, 90, 120, and 150 mL) was advised. Ghee was given on an empty stomach with lukewarm water early in the morning. After five days of internal oleation, Samyak Sidhhi Lakshana (~symptoms of proper internal oleation) was observed, including softness and unctuousness of skin, as well as passing soft stools. For the next three days, therapeutic message was done with Bala Taila followed by sudation therapy with Dashmoola Kwatha. Virechana was done with Trivritta Avaleha (60 g with lukewarm water between 10 and 11 AM) with 25 Vegas. After that, a seven-day plan of therapeutic dietary regime was included, with watery gruel prepared from barley for the first three diets, followed by a thick gruel of rice, soup prepared from green gram, and mutton soup for succeeding three diets each, in that order. During the course of treatment, the patient was advised to take only wholesome food and to follow a suitable lifestyle. After the completion of the therapeutic dietary regime, oral medications, that is, 2 g of Kanchnaar Guggulu (four tablets each of 500mg) daily in two divided doses with 40 mL of Varunaadi Kashaya on an empty stomach early in the morning and the evening were advised. All the drugs were procured from the Pharmacy of the CBPACS Hospital, New Delhi.
Pathya (Wholesome) and Apathya (Unwholesome)
The patient was advised to take diet items such as Yava (Hordeum Vulgare), Bajra (Pennisetum glaucum), Jovar (Sorghum), and Ragi (Eleusine coracana); vegetables such as Radish (Raphanus raphanistrum), Mustard (Brassica nigra. L.), Drumsticks (Moringa oleifera), and Gandeera (Plectranthus scutellarioides); spices such as Shunthi (dried rhizome of Zingiber officinale Roscoe) and Jeeraka (Cuminum Cyminum L.); Trikatu (buttermilk); and Ushna Jala (Lukewarm water). The diet was a light one, and foods that contain iodine, for example, brown algae, Beetroot (Beta vulgaris), Radish, Parsley (Petroselinum crispum), fish, oatmeal (Avena sativa) etc. were advised. The patient was also advised to practice activities such as regular exercises, Yogasanas, Pranayama (control of breath) such as Surya Bhedana, Kapalbhati etc. regularly.
The patient was asked to avoid heavy foods and fried preparation, refined foods such as white refined flour, Black Gram (Vigna mungo), Peas (Pisum sativum), Potatoes (Solanum tuberosum), curd, milk, fermented and bakery items, salted confectioneries, chips, and pickles. The consumption of goitrogenic foods such as Cabbage (Brassica oleracea var. capitate), Brussels sprouts (Brassica oleracea var. gemmifera), Broccoli (Brassica oleracea var. italica), Cauliflower (Brassica oleracea var. botrytis), Sweet Potatoes (Ipomoea batatas), Maize (Zea mays), Lima Beans (Phaseolus lunatus), and Soya (Glycine max) should be limited. Caffeine drinks such as coffee and cola should be avoided.
The patient was asked to avoid activities such as a sedentary lifestyle, day sleep, munching etc.Asanas that compress and stretch the throat space are beneficial to the thyroid gland and are useful for both hyper and hypothyroidism, as they stimulate the blood flow, which provides nourishment to the cells and helps the thyroid to do its work properly. Among Pranayamas (control of breath), Ujjayi is the most effective Pranayama for thyroid imbalance as it directly acts on the throat area and has a relaxing and stimulating effect. It also has a warming effect that will help people whose thyroid imbalance makes them feel constantly cold.
Outcome Measure and Follow-up
For objective assessment, a thyroid function test (TFT) was done; for subjective assessment, a symptom rating scale was made, which is as follows [Table 2][Table 3][Table 4].
|Table 3: Assessment of the Roga Bala (strength of disease) of the patient during the study|
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|Table 4: Assessment of the Agni Bala (strength of metabolic factors) of the patient during the study|
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| Results and Follow-up|| |
The result was assessed on the basis of the level of TSH and an improvement in the general condition of the patient. The level of TSH decreases from 64.4 µIU/mL to 2.65 µIU/mL during the duration of six months ([Table 5] [Figure 1][Figure 2][Figure 3]).
|Table 5: Assessment of the patient during the study in terms of objective criteria|
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| Discussion|| |
Normalcy of all mechanisms of the body is totally dependent on the normal functioning of Agni. According to allopathic systems, metabolic activity of the body is controlled by thyroid hormone secretion. It is also described in Ayurveda texts that metabolic processes of the body are under the control of Jatharagni and Dhatwagni. So the cause of the disease, that is, impaired metabolism can be compared with the vitiation of Agni according to Ayurveda. The treatment of hypothyroidism should aim at improvising the Agni, which is the main seat of pathogenesis.
The prospective of treatment is the use of herbal plant extracts or formulations to balance bodily humors with Anti-Kapha (Dosha responsible for regulating body fluids and keeping the body constituents cohesive), Anti-Meda (fat tissue), and Pitta (Dosha responsible for regulating body temperature and metabolic activities), enhancing properties and promoting lifestyle modification along with the adoption of Yoga. Due to increase Kapha Vata Dosha and decrease of Pitta Dosha that results decrease in the state of Agni and slow metabolism at tissue level especially fat tissues contributes to this condition. Drugs used for normalizing depressed metabolic factors located in Dhatu due to the increment of Vata and Kapha Dosha prove to be helpful in hypothyroidism.
Virechana (Therapeutic Purgation)
Therapeutic purgation is the most preferred purification in hypothyroidism, as it corrects Pitta (Dosha responsible for regulating body temperature and metabolic activities) related pathologies that are seen in hypothyroidism. It also helps in maintaining the proper functioning of Vayu. By virtue of its potency the Virechana drugs possesses hot, high potency, penetrating, quick spread even without digestion properties, It reaches to heart. The heart here can be considered as the nerve plexus in the brain, and it may help in balancing the hypothalamo-pituitary thyroid axis.
Probable Mode of Action of Kanchnar Guggulu
Kanchnara (Bauhinia variegata Linn.) is a useful drug for disorders related with swelling., It also helps to maintain the Pitta (Dosha responsible for regulating body temperature and metabolic activities) and Kapha (Dosha responsible for regulating body fluids and keeping the body constituents cohesive), which help to increase the digestive fire. In Ayurveda classics, it is described that Guggulu (Commiphora mukul Hook.ex Stocks) has Vata (Dosha responsible for movement and cognition) and Medohara (hypolipidemic) properties. It possesses Rukṣha (dry) and Lekhana (scrapping) properties, which help to reduce the excessive Kapha and Meda in the body. There was experimental study conducted by Veena et al. for the Water soluble fraction of total alcoholic extract of Bauhinia variegata Linn. at a dose of 2 g/kg was fed to Neomercazole (150 mg/kg) induced hypothyroidic rats (n = 12 in each group) for 20 days. The experiment resulted in enhanced thyroid function, as evidenced by increased thyroidal weight (P < 0.001), I-131 uptake and decreased serum cholesterol (P < 0.05 for both), and active thyroidal histology.
Probable Mode of Action of Triphala
The well-known Ayurveda herbal remedies combination of Haritaki (Terminalia chebula Retz), Amalaki (Emblica officinalis Gaertn), and Bibhitaki (Terminalia bellirica [Gaertn.]) helps in enhancing the bowel movement, ultimately improving the digestive fire. It possesses digestion and metabolism-enhancing properties, regularizes the physiological movement of Vata Dosha, and cleanses the channels (Srotas). Hence, Triphala could correct the state of diminution of metabolic factors and that is one of the main factors concerned in the pathogenesis process of hypothyroidism according to Ayurveda. Various scientific researchers have demonstrated that Triphala stimulates bile secretion, improves digestion, and helps to maintain the lipid profiles (as hypercholesterolemia occurs due to hypothyroidism).
Varunadi Kashaya contains main ingredients such as Varuna (Crateva religiose), Shatavari (Asparagus racemosus), Karanja (Millettia pinnata), Bhallataka (Semecarpus anacardium) etc. Most of the ingredients are pacified by Kapha and Vata Dosha and have properties, that is, Teekshna (high potency). Hence, Varunadi Kashaya is indicated in the disorders related with vitiated Vata and Kapha Dosha, which help to maintain the digestive fire and normal metabolism. Its bark is used in different thyroid disorders.
| Conclusion|| |
With the help of Panchkarama procedures and internal drugs, including diet and lifestyle modification, the metabolic process can be normalized, which helps to manage metabolic disorders such as hypothyroidism. In addition, it is helpful to improve the quality of life of patients and provide symptomatic relief too.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Patil N, Rehman A, Jialal I. Hypothyroidism [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021. Available from:https://www.ncbi.nlm.nih.gov/books/NBK519536. [Last accessed on 2021 August 24].
Hoogendoorn EH, Hermus AR, de Vegt F, Ross HA, Verbeek AL, Kiemeney LA, et al
. Thyroid function and prevalence of anti-thyroperoxidase antibodies in a population with borderline sufficient iodine intake: Influences of age and sex. Clin Chem 2006;52:104-11.
Larry J, Dennis L, Fauci S, Hauser L, Joseph L. Endocrinology and metabolism. In: Harrisons’ Principle of Internal Medicine. 18th ed., Vol. 2, Part 16. Bartley: Mcgraw Hill Education and Publication; 2018. p. 2918.
IAS.0kochupillai. Prevalence of hypothyroidism. Available from: http://www.ias.ac.in/currsci/oct252000/n%20kochupillai.PDF. [Last accessed on 2011 April 2].
Shastri A. Sutra sthana, Nidana sthana. Ch. 11, ver. 22. In: Sushruta Samhita. 2nd ed. Varanasi, UP: Chaukhamba Sanskrit Sansthan; 2010. p. 356.
Chatuvedi GK, editor. Chikitsa sthana. Ch. 12. In: Charak Samhita of Agnivesh. Varanasi, UP: Chaukhamba Bharati Academy; 2009. p. 372.
Tripathi HP. Tritya sthana. Ch. 38, ver. 34. In: Harita Samhita. 1st ed. Varanasi, UP: Chaukhamba Sanskrit Sansthan; 2005. p. 412.
Shastri K, Chatuvedi G, editors. Vimana sthana. Ch. 8, ver. 22. In: Charak Samhita of Agnivesh. Varanasi, UP: Chaukhamba Orientalia; 2011. p. 273.
Shastri K, Chatuvedi G, editors. Siddhi sthana. Ch. 3, ver. 10. In: Charak Samhita of Agnivesh. reprint ed. Varanasi, UP: Chaukhamba Bharati Academy; 2009. p. 691.
Shastri K, Chatuvedi G, editors. Sutra sthana. Ch. 13, ver. 58. In: Charak Samhita of Agnivesh. Varanasi, UP: Chaukhamba Bharati Academy; 2009. p. 85.
Shastri K, Chatuvedi G, editors. Siddhi sthana. Ch. 01, ver. 11. In: Charak Samhita of Agnivesh. Varanasi, UP: Chaukhamba Bharati Academy; 2009. p. 678.
Gerson S. The Gerson Institute of Ayurvedic Medicine. Ayurveda. Available from: http://ayurveda.md/index.php?option=com_content& view=article&id=133&Itemid=1. [Last accessed on 2021 July 24].
Hubleur AV. Hypothyroidism and yoga; 2013. Available from: http://yoga-india.net/wp-content/uploads/2014/04/Hypothyroidism-Redaction-Anne-Valeri.pdf. [Last accessed on 2021 April 4].
Shastri K, Chatuvedi G, editors. Chikitsa sthana. Ch. 15, ver. 3. In: Charak Samhita of Agnivesh. Varanasi, UP: Chaukhamba Surbharati Prakashana; 2011. p. 512.
Shastri K, Chatuvedi G, editors. Sutra Sthana. Ch. 12, ver. 11. In: Charak Samhita of Agnivesh. Varanasi, UP: Chaukhamba Surbharati Prakashana; 2011. p. 80.
Gapat VN. Patho-physiology of hyperthyroidism & their Ayurvedic management. AIIRJ 2016;3:57-62.
Veena K, et al
. Effect of indigenous drugs on experimentally produced goiter. J Res Ind Med1975;10:19.
Sharma PV, editor. Dravya Guna Vigyana. 3rd ed. Varanasi, UP: Chaukhamba Bharti Academy; 2006. p. 236.
Shastri JLN. Illustrated Dravyaguna Vijnana. 2nd ed. Varanasi, UP: Chaukhamba Sanskrit Series; 2005. p. 115-9.
Shrikanth Murthy KR, translator. Sutra sthana. Ch. 13, vol. I, ver. 2. In: Astanga Sangraha of Vagbhatta. reprint ed., Delhi: Chaukhambha Sanskrit Pratisthana; 2007. p. 279.
East West School of Planetary Herbology. Specific herbs. Available from: https://planetherbs.com/research-center/article-topics/specific-herbs. [Last accessed on 2021 March 30].
Shastry HS, editor. Sutra sthana, Ch. 15, ver. 16. In: Astanga Hridaya. Varanasi, UP: Chaukhamba Surabharathi Prakashana; 2007. p. 236.
Rao VG, Annamalai T, Mukhopadhyay T. Chemical examination and biological studies on the bark of Crataeva nurvala Buch.-Ham. Pharm J 2011;3:1-4.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]