Effective management of Hypothyroidism through Virechana - A Case Study

KH Misriya; Ananta S Desai; Shaila Borannavar

Effective management of Hypothyroidism through Virechana - A Case Study

Misriya K.^1*, S Desai A.², Borannavar S.³

DOI:

^1* KH Misriya, Post Graduate Scholar, Department of PG Studies in Panchakarma, Government Ayurveda Medical College, Bengaluru, Karnataka, India.

² Ananta S Desai, Professor and HOD, Department of PG Studies in Panchakarma, Government Ayurveda Medical College, Bengaluru, Karnataka, India.

³ Shaila Borannavar, Associate professor, Department of PG Studies in Panchakarma, Government Ayurveda Medical College, Bengaluru, Karnataka, India.

Thyroid gland is an endocrine gland in neck. It makes two hormones that are secreted into the blood. Thyroxine (T4), triiodothyronine (T3), These hormones are necessary for all the cells in body to work normally. Principal function of thyroid gland acts as catalyst for the maintenance of oxidative metabolism. Hypothyroidism is the most common endocrine disorder observed all over the world in present time. The normal and abnormal functions of thyroid gland can be co-related to healthy and altered status of Agni. So, hypothyroidism can be considered as a stage of Agnimandya, resulting in the formation of Ama leading to Bahudoshavastha. In the Bahudoshavastha condition of Ama, Doshavasechana is done. In this case study Virechana is performed by Trivrith Lehya after performing Deepana-Pachana and Shodhananga Snehapana with Guggulu Tiktaka Gritha. This study shows significant improvement in signs, symptoms of hypothyroidism and thyroid function test.

Keywords: Hypothyroidism, Panchakarma, Virechana

Corresponding Author	How to Cite this Article	To Browse
KH Misriya, Post Graduate Scholar, Department of PG Studies in Panchakarma, Government Ayurveda Medical College, Bengaluru, Karnataka, India. Email:	KH Misriya, Ananta S Desai, Shaila Borannavar, Effective management of Hypothyroidism through Virechana - A Case Study. J Ayu Int Med Sci. 2022;7(10):280-284. Available From https://www.jaims.in/jaims/article/view/2141

Introduction

Hypothyroidism also known as under reactive thyroid disease is a common disorder with hypothyroidism, thyroid gland does not make enough thyroid hormone. Thyroid controls how one’s body cells use energy from food, a process called metabolism among other things. Metabolism affects body’s temperature, heartbeat and how well one burn calories. If a person doesn’t have enough thyroid hormone body process slowdown that means, body makes less energy and metabolism becomes sluggish.

The prevalence of hypothyroidism was the highest in the age-group of 46 to 54 years (13.11%) and the lowest in that of 18 to 35 years (7.53%). Table 2 Prevalence of thyroid disorders in eight urban cities of India A larger proportion of females than males (15.86% vs. 5.02%; P < 0.0001) were found to be affected by hypothyroidism.^[1]

Main causes of Hypothyroidism

The main causes of hypothyroidism can be classified into:

1. Primary (thyroid failure)

Hypothyroidism, caused by the inability of the thyroid gland to make T3 and T4 hormones, is called primary hypothyroidism; Primary hypothyroidism is a condition of decreased hormone production by the thyroid gland, it accounts for 95% of hypothyroidism cases; only five percent or less are suprahyoid in origin.

The most common cause of primary hypothyroidism is:

a. Iodine deficiency

b. AITDs (Autoimmune thyroid diseases)

c. Drugs

d. Iatrogenic

e. Congenital

Transient hypothyroidism includes silent and part partum thyroiditis.

2. Secondary (due to pituitary TSH deficit);

3. Tertiary (due to hypothalamic deficiency of TRH).

Hypothyroidism is one of the most undiagnosed and

misdiagnosed diseases, as its clinical features are notorious. Hypothyroidism doesn't have any characteristic symptoms, and many symptoms of this condition can occur in people with other diseases. Vertigo, mood disturbances, easy fatigability, tiredness, lethargy, slowness of memory, intellect and thought were the early symptoms, and Paraesthesia, muscle cramps, weakness, muscles stiffness and aching were the main complaints of the chronic cases.^[2]

Many of the symptoms of Hypothyroidism can be correlated with Lakshanas (Symptoms) mentioned in Ayurveda. Excessive accumulation in the body is called Bahudhoshavastha. This condition is aptly suitable for Samshodhana or Panchakarma (detoxification) therapy. In this clinical study management of hypothyroidism done with Virechana Karma.

Case Report

Chief complaints

The present case study is on management of Hypothyroidism through Panchakarma. A 35-year-old female having Hypothyroidism reported to Panchakarma outpatient department (OPD) of SJJIM hospital, Bengaluru with chief complaints of

Increased weight gain for 6 months
Constipation in the past 3 months
Excessive hair falls in the last 5 months
Generalized debility in the last 6 months.

Associated complaints

Pain in the bilateral knee joint in the past 2 months.

History of present illness

A patient aged about 35 years apparently normal before 2 years, then gradually started generalized debility, tiredness during pregnancy, undergone thyroid check-up diagnosed as hypothyroidism she was on medication for the same during pregnancy. After successful delivery she discontinued medicines. After 4 months of delivery again started weight gain, constipation, mood swings and generalized debility again she undergone thyroid profile. TSH vale was high.

For better management she approached Ayurvedic treatment and admitted in SJIIM hospital on 15/09/2021.

Personal history

Table 1: Showing subject’s personal history

Name - XYZ	Bowel habit - Constipated
Age - 35 years	Appetite - Moderate
Marital status - Married	Menstrual history - Regular
Occupation - Research Analyst	Weight - 81 kg
Bala - Madhyamika	Height - 158cm
Sleep - Sound	Addiction - none

Clinical Findings - Physical examinations

Showing subject’s Asta Vidha Pareeksha

Nadi - Kapajanadi, 67/min
Mala - Prakruta, 1 time /day
Mutra - Prakruta, 4-5 time/day
Jihva - Alipta
Shabdha - Prakruta
Sparsha - Anushna Sheetha
Drik - Prakruta
Akriti - Sthula

Showing subject’s Dashavidha Pareeksha

Prakriti - Kapha Pitta
Aharaja Hetu - Anupa Mamsa, Madhura Ahara
Viharaja Hetu - Avyayama, Diwaswapna
Dosha - Kapha Pitta
Dushya - Rasa, Meda And Mamsa
Desha - Anupa
Sattva - Madhyama
Sara - Medosara, Mamsasara
Samhanana - Madhyama
Pramana - Sthula

Ht - 5.7ft
Wt - 81 kgs

Satmya - Madhyama
Ahara Shakthi

Abhyavarana Shakthi - Uttama
Jarana Shakthi - Uttama

Vyayama Shakthi - Avara
Vaya - Madhyama/35 Years
Bala - Madhyama

Systemic examination

CNS

Conscious and oriented to time, place and person.

CVS

S1, S2 heard, no added sounds.

R S - NVBS heard.

P/A - soft, non-tender.

Treatment Schedule

Virechana Karma

Poorvakarma

Deepana-Pachana with Chitrakadi Vati 2 TID for 3 days.
Snehana with Guggulu Tiktaka Gritha for 4 days.

Table 2: Showing Snehapana dose schedule

Date	16/10/2021	17/10/2021	18/10/2021	19/10/2021
Time	6:00am	6:00 am	6:00 am	6:00 am
Time taken for digestion	5 hours	10 hours	11 hours	13 hours
Dose	30ml	70ml	100ml	160ml

Sarvanga Abhyanga with Murchitha Tila Taila followed by Nadisweda for 3 days.

Pradhana Karma

Virechana Karma

Yoga - Trivrith lehya
Dose - 60 gm
Anupana - Warm Milk

Pashchath Karma

Peyadi Samsarjana Karma for 5 days.

Table 3: Showing Assessment

SN	Lakshanas	Before treatment	After Treatment
1.	Increased weight gain	81 kgs	74 kgs
2.	Constipation	++	-
3.	Hair fall	+++	++
4.	Generalized debility	+++	++
5.	Knee joint pain	++	+

(+++) severe presentation of symptoms, (++) moderate presentation of symptoms, (+)

Mild presentation of symptoms, (-) no symptoms)

Before Treatment

After Treatment

After Follow-Up

Discussion

Hypothyroidism is a pathological condition of thyroid gland with deficiency of thyroid gland hormones. On the basis of Ayurvedic fundamentals it becomes evident that Kapha associated with Pitta Dushti and vitiation of Vayu result in vitiation of Agni.^[3] All these factors finally lead to Annavaha and Rasavaha Srotodushti predominantly. As there is no direct correlation of hypothyroidism in ayurvedic classics, based on the Lakshanas it can be considered under the Bahudoshavastha.

Samshodhana is indicated in Bahudoshavastha (i.e., when Doshas are aggravated some diseases like Sthoulya, Tandra, excess Kapha and Pitta Dosha, Santarpana Janya Vyadhi are included in Bahudoshavastha Lakshanas.^[4] As subject suffering from digestive disturbances, constipation, Mandagni etc which indicates the involvement of Pittasthana.

Virechana is the best treatment for Pitta and Pitta associated with Kapha or Vata, and eliminates Pitta from Pittasthana and Kaphasthana.^[5] Production of Ama is the result of Avarana of Pittasthana by Kledakakapha, thus hampering the digestive activity of the Pachaka Pitta. In this case Virechana is preceded by Deepana-Pachana, after Doshas attain Niramavastha and may require elimination from the body by Shodhana.

Snehapana is done by Guggulu Tiktaka Gritha as it is used in the preparatory procedure of Panchakarma and Jatrurdhavagata Vyadhis. And also, it acts on Tridosha and bring the Dosha from Shakha to Kosta.^[6]

Mode of action of Virechana Karma

Virechana drug possessing properties like Ushna, Teekshna, Sukshma, Vyavayi, and Vikasi reaches the Hridaya by virtue of its Veerya and then following the Dhamani, it pervades the whole body through large and small Srotas and removes the Doshas out of the body. Virechana drugs carry out the therapeutic purgation due to their Prabhava (potency). As these drugs are having Jala and Prithvimahabhuta dominancy, they have natural tendency to go downward and thus they can help in induction of purgation.^[7]

Conclusion

Thyroid hormones are the hormones that controls body’s metabolism, the process in which body transform the food into energy. Purification (Shodhana) followed by palliative therapy was found as a suitable treatment plan to manage hypothyroidism. Virechana procedure is the common adopted purificatory process with maximum efficacy. The outcome of the study conducted on hypothyroidism had concluded that Virechana Karma plays an important role in providing significant relief in the various sign’s symptoms and haematological parameters of the disease.

Reference

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743364.

2. www.positivehealth.com/article/ayurveda/management-of-hypothyroidism.

3. Prasuna VVL. Textbook of Thyroid in Ayurveda. Part 2, Varanasi, Chaukambha Sanskrit Series. 31/12; 2010, p50.

4. Acharya YT ed. Charaka Samhita of Agnivesha elaborated by Charaka and Dridabala with Ayurveda Dipika commentary by Sri Chakrapanidatta, Sutrasthana, 16th chapter, 13-16th verse, Varanasi: Chaukhamba Sanskrit Sansthan. 2017,p97.

5. Vagbhata, Astanga Sangraha, Shashilekha Sanskrit commentary of Indu; edited by; B Rama Rao, Chaukambha Vishwabharathi, Varanasi. Sutrasthana 27th chapter 5th verse, p384.

6. Pt. Paradakara HSS, ed. Astanga Hrdaya of Vagbhata with the commentaries Sarvangasundara Arunadatta and Ayurveda rasayana of Hemadri, Chikitsasthana, 21th chapter, 58-61 verse Varanasi: Chaukhamba Surbharati Prakashana 2020,p726.

7. Acharya YT ed. Charaka Samhita of Agnivesha elaborated by Charaka and Dridabala with Ayurveda Dipika commentary by Sri Chakrapanidatta, Kalpasthana 1st chapter, 5th verse, Varanasi: Chaukhamba Sanskrit Sansthan 2017,p671.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-09-28	2022-09-30	2022-10-07	2022-10-14	2022-10-21
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Hypothyroidism

Journal of Ayurveda and Integrated Medical Sciences