E-ISSN:2456-3110

Case Report

Hypothyroidism

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 11 November
Publisherwww.maharshicharaka.in

Case study on Hypothyroidism - A Srotorodh Pradhan systemic disease

Sokiya G1, Aggarwal A2*, Dalel R3, Sharma G4
DOI:10.21760/jaims.8.11.35

1 Gracy Sokiya, Assistant Professor, Department Of Kayachikitsa, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.

2* Ankita Aggarwal, Post Graduate Scholar, Department Of Kayachikitsa, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.

3 Rajan Dalel, Post Graduate Scholar, Department Of Kayachikitsa, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.

4 Gaurav Sharma, Assistant Professor, Department Of Kayachikitsa, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.

Since the disease nowadays is more prevalent in women than man due to various causes in which menstrual irregularities is one of the common causes seen and since, the symptoms are very vague and hard to identify, the patients are unable to know the exact cause and approaches to doctor lately. Also, in Ayurveda it has no direct reference for correlation, so it can be just correlated with a Srotorodh Pradhan systemic disorder as its symptoms mimics the same. Here, a female patient of 47 years was taken under study for an integrated approach by Yoga (Setubandhasana, Halasana) and Pranayama (Ujjai) + Pathya Palan + Ayurveda medicines like Thyrogrit tablet, Kanchnar Ghanvati, Dashmool Kwath for a month and the symptoms and TSH levels were markedly decreased.

Keywords: Thyrogrit tablet, Dashmool Kwath, Pathya Palan, Setubandhasana, Ujjai

Corresponding Author How to Cite this Article To Browse
Ankita Aggarwal, Post Graduate Scholar, Department Of Kayachikitsa, Patanjali Bhartiya Ayurvigyan Evum Anusandhan Sansthan, Haridwar, Uttarakhand, India.
Email: 		Sokiya G, Aggarwal A, Dalel R, Sharma G, Case study on Hypothyroidism - A Srotorodh Pradhan systemic disease. J Ayu Int Med Sci. 2023;8(11):216-220.
Available From
https://jaims.in/jaims/article/view/2800

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-09-11 2023-09-16 2023-09-21 2023-09-26 2023-10-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.76%

© 2023by Sokiya G, Aggarwal A, Dalel R, Sharma Gand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Sedentary lifestyle is all that an individual wants to pursue life which ultimately leads to various lifestyle disorders like thyroid, diabetes, hypertension, obesity etc. The cases of hypothyroidism are increasing day by day thus, becoming one of the most common lifestyle disease with hormone replacement therapy also, which left untreated may become life threatening and ultimately fatal.

It is a condition with normal levels of thyroxine (T4) and triiodothyronine (T3) and mildly elevated levels of serum TSH to an overt state of myxedema, end-organ effects and multi-system failure.[1-4]

The patient presentation can vary from asymptomatic disease to myxedema coma. Today, the diagnosis of hypothyroidism is easily made with simple blood tests and can be treated with exogenous thyroid hormone.[5]

In the current scenario, there are 3.8-6% general population affected with hypothyroidism.[6]

In Ayurveda texts, a disease named Galganda has been mentioned whose symptoms mimics with that of hyperthyroidism. So, hypothyroidism is not restricted to Galganda. Since there is no direct correlation of hypothyroidism in Ayurveda texts, many diseases untold comes under the category of Anukta Vikara and can be discussed as a Vata-Kapha Dushti Janya Vyadhi.

Kaphavatvrudhhi with Pittakshya[7] - Increased Kapha with Vata Dosha and decreased Pitta Dosha results in the formation of Shaitya, Stambha, Gaourav, Agnimandya, Gatraparushya which resemble with the symptoms of SCH like Cold intolerance, Muscle weakness, Lethargy, Anorexia, Dry Skin & hair.

Also, according to Trividh Bodhya Sangraha i.e., mentioned in chapter 18 of Charaka Sutra Sthana, which denotes that there is no urgent need of giving a name to every condition which is not mentioned in Samhitas, directly one should focus on the doshas and symptoms involved in it, thus leading to Samya Avastha. Although, with lack of description of it, Samhita defined the line of treatment for the same very well.

Clinical manifestations of hypothyroidism range from life threatening to no signs or symptoms.

The most common symptoms in adults are fatigue, lethargy, cold intolerance, weight gain, constipation, change in voice, and dry skin, but clinical presentation can differ with age and sex, among other factors.[8]

A careful physical examination may reveal some clues since the signs of hypothyroidism are very subtle. Physical examination may be significant for the following:[9]

  • Enlarged thyroid gland
  • Weight gain
  • The slowness of speech and movements
  • Dry skin
  • Coarse and brittle hair
  • Pallor and jaundice
  • Dull facial expressions
  • Macroglossia
  • Bradycardia

Case Report

A female XYZ of K/C/O Hypothyrodisim X 3 years, age 47 years came to Patanjali Ayurveda hospital on 16/05/2023 with complaints of -

Table 1

SNVyadhi Lakshana Duration
1.Kesha Patana (hairloss)3 years
2.Sthaulya (obesity)3 years
3.Pada Shopha (swelling in B/L foots)2.5 years
4.Daurbalya (weakness)2 years

Patient have the above complaints from last 3 years, was on 150mcg Thyroxine therapy but the symptoms remained same with gradual increase in body weight.

Ashtavidha Pariksha

Table 2

1.Nadi (pulse)82/min (Kapha-Vata)
2.Mutra (urine)5-6/day (normal)
3.Mala (stool)Normal
4.Jihwa (tongue)Saama (Coated)
5.Shabda (speech)Normal
6.Sparsha (skin)Twak-Rukshta
7.Druka (eyes)Normal
8.Aakruti (built)Madhyama

Materials and Methods

Patient was given Ayurveda medications as following-


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Table 3

SNMedicationsDoseAnupana
1.Dashmool kwath40 ml X BD empty stomach-
2.Kanchnar Ghanvati (500mg)2 X BD After mealsWith normal water
3.Thyrogrit tablet2 X BD Before mealsWith Dhanyaka Phanta

Ayurvedic Overview

The pathogenesis and manifestations of hypothyroidism mainly occurs due to dysfunction of Agni. It starts with dietary habits - cold, heavy, sweet items and sedentary lifestyle i.e., lack of physical work, sleeping during day time and immediately after meals, excessive sitting, thus promoting in vitiation of Kapha Dosha which ultimately hampers the Jathargani, hence formation of Ama Dosha.

Analysis of hypothyroidism with reference to Ayurvedic principles of metabolism shows Agnimandya (Dhatvagnimandya) → Aam Doṣha → Kapha Prakopa and → Rasa Dhatu Duṣṭi as marked pathological features.

Dhatvagnimandya - especially Rasadhatvagni Mandyata leads to Sama Rasa Vriddhi leading to formation of Malarupi Kapha Vriddhi. Majority of Kapha Nanatmaja Vikaras can be considered under sign and symptoms of hypothyroidism i.e., Tandra, Atinidrata, Staimitya, Alasya, Gurugatrata, Atisthaulyata. Also, many of Rasaj Vikaras mentioned by Acharya Charaka are similar to the features of hypothyroidism like - Ashraddha, Gaurava, Tandra, Pandu Roga, Klaibya, Srotorodha, Agnimandya.[10]

Table 4

Kaphkara Ahara
↓
Agnimandya
↓
Sama Ahara Rasa - carried out by Vata in whole body → Forms Mala Rupi Kapha Vriddhi
↓
Srotorodha
↓
Hinder Uttarottara Dhatu formation
↓
Vikrit Dhatu Nirmana
↓
Vyadhi Utpatti like Gandmala, Arbuda, Granthi, Galganda

 The above table depicts the formation of Samprapti of hypothyroidism - a Srotorodh disease.

Management

Since the patient was already on Thyroxine 150 mcg since long time, we have slowly stopped it by tapering the dose daily for initial

7-10 days and keeping in mind the Srotorodha and Doshas Dhatus involved in the disease, one can easily manage the disease with ayurvedic formulations along with lifestyle modifications and Pathya diet such as-

Dashmool Kwath - [Laghu Panchmool - Vata Pitta Shamak, Brihat Panchmool - Vata Kapha Shamak][11]

It contains herbs with properties of entering in minute channels thus helping in alleviating Kapha Dosha with anti-inflammatory properties and analgesic effect. All of these drugs have Ushna Virya thus helping in pacifying Avarana caused by Kapha Dosha over Jatharagni.

Thyrogrit Tablet

Dhaniya (Coriandrum sativum) Kachnar Chhal (Bauhinia variegata), Singhada (Trapa bispinosa), Baheda (Terminalia belirica), Punarnava (Boerhaara diffusa) Trikatu (Sonth (Zingiber officinale) Pippal (Piper longum), Marich (Piper nigrum), Shuddh Guggul (Commiphora mukul) - these drugs overall helps in reducing glandular enlargement by reducing inflammation.

The Anupana chosen for thyrogrit tablet was Dhanyaka Phanta. Phanta Kalpana was taken considering patient’s Jatharagni here, as its Laghu (light to digest) among Panch Kashaya Kalpana, and Dhanyaka - coriander seeds are Katu, Rochan with Ushna Veerya helping in pacifying the Aama, thus breaking Samprapti of disease. 

Kanchnar Ghanavti

Contains Kanchnar Chaal as its prime content which is called as “Gandmalahar Dravya”, thus aims in relieving inflammation of thyroid gland.

Yoga and Pranayama

Yoga - The Yoga exercise like Halasana, Setubandhasana, Sarvangasana and Suryanamaskar were seen beneficial for hypothyroid patients. In these yogic exercises an enormous pressure is placed on the gland that may lead to beneficial effects by improving circulation to the gland.[12]

Pranayama was the perfect key to combat with the thyroid glands hypo-metabolism, useful in increasing the metabolic rate of the body thus, helping in its regulation in the natural way. The pranayama helpful was Ujjayi, Bhastrika, Kapalabhati


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which showed significant relief along with the medications.

Ujjayi Pranayama, also called as psychic breath acts on the throat area as relaxing and stimulating effect along with the other Pranayama were done for approximately 30-45 minutes two times daily for a month on regular basis.[13]

Pathya Ahara Vihara

Since the basic cause of all the symptoms are due to Santarpana Aahara/Viharas,[14] so for it, the treatment followed is Aptarpana.[15,16] Also, keeping in mind about the vitiation of Vata along with Kapha Dosha in Hypothyroid, the food which decreases Jatharagnimandya, Datvangimandya, relives Strotorosh and Aam, decreases Kapha without vitiation of Vata were strictly advised to the patient as mentioned-

Table 5[17]

SNDietProperties
1.Ushna JalaDipan, Pachan, Laghu, Vatakaphanashak, Kanthya (Useful in Kantha Roga)
2.Yava flour or Yava DaliyaRuksha, Sheeta, Aguru  / non-heavy, Prabhut Malakrut, Kaphavikarnut, Shulvilekhancahhach
3.Amla / Jambu Swaras / juiceRuksha, Kashay, Amla, Tridoshaghna / Grahi, Kaphapittaghna.
4.Butter milkRuksha, Sheeta, Laghu, Vatakaphahar
5.Cow milkGuru, Sheeta, Ashigdha, Rasayan
6.Vegetables like Karvellak, Patol, VartakTikta, Rochan, Laghu, Agnidipak, Kaphavatahar.
7Sarshap Tail / Erand Tail Kashay, Ushan, kaphavatahara / Kashay, Ushna, Vyavayi, best Vatahara
8Shashti Shali / Rakta Shali Tridoshahar, Svarya, Mutral

Result

 Reports before and after treatment
Jaims_2800_1.jpg

Jaims_2800_02.jpg

A significant relief in the symptoms of the patient was seen in the duration of 1 month along with marked decline in the high values of TSH levels as shown below.

Changes in Thyroid profile

Table 6

Thyroid ProfileBefore T/T (16/05/2023)After T/T (19/06/2023)Normal Range
TSH9.93 µIU/ml4.40 µIU/ml0.35-5.50 µIU/ml

Discussion

Lifestyle disorders are becoming burden as its cases are increasing day by day, thus confounding daily activities. Ayurveda here becomes the best solution in such type of Anukta Vikaras where the patient was told to consume tablet thyroxin throughout lifetime.

Ayurveda cure such disease & act as Apunarbhava (stops recurrence) also.[18] This is one example of successful case of subclinical hypothyroid patient with significant relief by correcting the Jatharagni as Jathargni is responsible for the Aayu, Varna, Bal, Swasthya, Utsaha, Oja, Teja, Dhatvagni and Pran of a human being.

References

1. Cooper DS. Clinical practice. Subclinical hypothyroidism. N Engl J Med. 2001;345:260-5.

2. Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004;363:793–803.


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3. Biondi B, Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrine. 2004;24:1–13.

4. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev. 2010;31:702–55.

5. Patil N, Rehman A, Jialal I. Hypothyroidism. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519536/.

6. Wikipedia contributors. Lifestyle disease [Internet]. Wikipedia, The Free Encyclopedia; 2023 [cited 2023 Aug 9]. Available from: https://en.m.wikipedia.org/wiki/Lifestyle_disease.

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8. Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017 Sep 23;390(10101):1550-1562. doi: 10.1016/S0140-6736(17)30703-1. Epub 2017 Mar 20. PMID: 28336049; PMCID: PMC6619426.

9. Patil N, Rehman A, Jialal I. Hypothyroidism. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

10. Shastri Kashinath, Chaturvedi Gorakhnath edited Charak Samhita of Agnivesha, Revised by Charak and Dridhabala, Part I, Reprint., 2004; Sutra Sthana, 20/17; 405. Chaukhamba Bharati Academy, Varanasi.

11. Taru, Poonam & Syed, Sabeena & Kute, Pournima & Shikalgar, Malan & Kad, Dhanshree & Gadakh, Archana. (2022). DASHAMOOLA: A SYSTEMATIC OVERVIEW. GIS-Zeitschrift fü Geoinformatik. 9. 1334-1345.

12. YogaWiz. Yoga for Hypothyroidism [Internet]. Available from: http://www.yogawiz.com/health-issues-andyoga//yoga-for-hypothyroidism.html.

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Charaka, Charak Samhita, Text with English translation by, Volume 01, Reprint 2008, Sutrasthana 23/3-7. Page No. 154 16), Chaukhamba Orientalia Varanasi.

15. Ganesh Krushn Garde, Vagbhata, Ashtangahrudya, Sarth Vagbhata, Reprint 2005 Sutrasthana, 14/1, 12-14 Pg.No. 63-65. 17), Anmol Prakashana Pune.

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17. Agnivesha, Charaka, Charak Samhita, Text with English translation by Satyavrat Sharma, Volume 01, Chaukhamba Orientalia Varanasi, Reprint 2008, Sutrasthana, Annapanvidhidyaya. Page No. 193-225.

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