We Ayurvedic practioners are least concerned about thyroid disorders. Most of us think that thyroid disorder is a hard nut to crack and it can be managed only through allopathic interventions. It is high time to formulate an ayurvedic approach to tackle this issue.
In 30yrs of practice I have come across many hypo and hyper thyroidism cases and found some formulations effective in treating the same.
Let us see in brief about the thyroid gland and its disorders
Anatomy of Thyroid Gland
Thyroid is a butterfly shaped endocrine gland situated below larynx and on the sides of trachea, weighing 25gms, measuring 4*3*2cm.
Parathyroid glands are embedded in it.
Important point to be noted here is it has one of the richest blood supply, and in disorders like goiter it can weigh upto 250gms or more.
Synthesis of thyroid hormones
Production of thyroglobulin by follicles
Storage as colloid form
Iodination
Degradation of thyroglobulin
Secretion of thyroid hormones
Hypothalamus releases TRH (thyroid releasing hormone)which stimulate Pituitary gland to secrete TSH ( thyroid stimulating hormone) which in turn stimulate Thyroid gland to secrete Thyroxine (T4) and Triiodotyronine (T3)
Clinical biochemistry adult reference ranges
TSH- 0.3-4.0 mU/L
Thyroxine, free(fT4)- 11-25 pmol/L
Thyroxine, free(fT4)- 1st trimester- 11.6-19.2 pmol/L
Thyroxine, free(fT4)- 2nd trimester- 9.3-16.3 pmol/L
Thyroxine, free(fT4)- 3rd trimester- 8.0-15.2 pmol/L
Thyroxine, total (tT4)- 58-140nmol/L
Tri-iodothyronin(T3)-1.2-2.2 nmol/L
Thyroid function test
Total T3 - 0.600-1.800ng/mL
Total T4 - 4.600-11.500microgm/dl
TSH - 0.350-5.500mIU/L
Actions of Thyroid Hormones
Increase cellular oxidation (BMR)
Increase in protein breakdown
Increase in turn over of carbohydrates and fats
Calcium mobilised from bones
Increased heart rate
We can see that above said functions are more of catabolic in nature. But In intra uterine stage, infancy and in growing stages thyroid act also as an anabolic hormone. So we can say that thyroid is essentially a gland related to metabolism.
Salient Features and Facts of Thyroid Disorders
5% of population is affected
Females are more prone, ratio 8:1
Females with diabetis mellitus are more prone to develop
Misdiagnosis (most of us fail to diagnose hypo and hyper thyroidism cases)
Malignancy
Role of auto-immunity
We can see that prevalence of thyroid disorders is quite high and females are more prone . .Hypothyroid females are susceptible to develop D.M. and vice versa due to immunological backgrounds. Rheumatoid Arthritis also usually associate due to the same reason.
Various autoantibodies have been detected which play an important role in genesis of thyroid disorders
Thyroid related malignancies are also found considerably
Diseases of Thyroid Gland
Goiter
Hypo thyroidism
Hyperthyroidism
Thyroiditis
Tumors
Hypothyroidism :
Insufficient synthesis and secretion of thyroid hormones leads to hypothyroidism.
1. Marked hypothyroidism
a) Cretinism (children)
b) Myxedema (Adults)
2. Mild to moderate hypothyroidism
Hypothyoidism and Heredity
Though there is no reference of heredity,many physicians have found certain families where thyroid stops to secrete for ever.This happens at 3rd or 4th decade
Cretinism :
Infant born to hypothyroid women
Infant born in endemic goiter belt
Infant born to women on ‘antithyroid drugs’ (pregnant women who is on medication for hyperthyroidism if not monitored properly will develop hypothyroidism and baby born will be cretin.
Symptoms of cretinism:
Dull and lethargic
Retarded growth
Large protruding tongue
Broad flat nose
Croky voice
Somnolence ( the baby sleeps upto 18hrs a day)
Constipation
Neurological abnormalities
Myxedema : (in adults)
Symptoms are
Lethargy and somnolence
Slowing of activities
Slowing of mental activities
Depression
Weight gain
Constipation
Hair coarse and dry
Hair Fall
Generalised non pitting odema
Periorbital odema
Puffy face and macroglossia
Intolerance to cold
Heavy menstrual periods
Diabetes Melitus, Arthritis, CVS ailments
Enlarged thyroid
Important points to remember while treating hypothyroidism
Quite frequent in daily practice
Diabetic women are more prone
Often Arthritis coexists with hypothyroidism, and most of us miss hypothyroidism.
Often a middle aged lady with puffines ,recently overweight,lack of energy and having jontpain is a common customer in our day to day practice,and we diagnose the case as a sandhigatha vata one and starts treatments.If we go for thyroid investigation most of such cases turned out to be hypothyroidism to which modern doctors start eltroxin So we should not missdiagnosis
HYPOTHYROIDISM –Management through Ayurveda
In my clinical experience myxedema and cretinism couldn’t be managed through ayurveda. But mild to moderate hypothyroidism with following conditions can be successfully managed.
Females/males 40 yrs above, normal thyroxine level and elevated TSH
Dullness
Puffiness
Arthralgia
Constipation
Weight gain
Eltroxin dose insufficient,fails to reverse symptoms
when patient willing to withdraw ‘ eltroxin’
when D.M. etc.follows
In our day to day practice we encounter female patients above 40yrs with symptoms 1-5 taking ‘eltroxin’ , such cases can be effectively managed.
Often we can see that inspite of taking ‘eltroxin’ regularly, patient still has the above said symptoms which cannot be reversed even with high doses , here ayurvedic approach does wonders.
When we go through the symptoms of hypothyroidism we can see the role of dosas and dusyas
Relation with Doshas and dusyas
Kapha vridhi
Medo vridhi
Tamoguna vridhi
Symptoms related to Kapha
Lethargy
Somnolence
Slowing of physical activities
Slowing of mental activities
Oedema
Intolerance to cold
Weight gain
Periorbital oedema & puffy face
D.M, Hyperlipidaemia
Cardio vascular problems
Absence of sweating despite heavy activity [ Diagnostic pointer]
Symptoms related to Medas
Almost all symptoms of kapha vridhi
Enlarged thyroid
Symptoms related to Tamo Guna
Lethargy
Somnolence
Slowing of mental activities
Depression
From the above we can conclude that symptamatology of hypothyroidism go hand in hand with Kapha Medo Vridhi and lethargy etc symptoms are due to the dominance of Tamo Guna. There are some symptoms which cannot be included under kapha medo vridhi viz. Constipation, Arthritis [?Adyavatha], Muscle cramps and aches
,Hair fall ( I have seen this as one of the first symptoms in many cases) Heavy menstrual periods. This symptom cannot be categorized under kapha medovridhi
Treatment protocol for hypothyroidism:
Basic line of treatment to tackle Kapha , Medo vridhi
Effective proven formulations
Measures to kindle Jataragni should be our main aim while treating hypothyroidism.
Upavasa
Kapha hara food –(rooksha-alpa-katu ahara)
Udwarthana
Rooksha sweda
Vyayama –yogasanas - breathing exercises
Lekhana vasti
Vamana , nasya, dhoomapana-(Avasthaanusari)
Vishishta prayogas-Toyavidhi- Panchakola or Naagara
Upavasa..As jadaragni is set in low and appetite poor patient should be advised to cut supper stick on kaphahara food..Panchakola jalam acts as deepana and pachana .It also relieves menstrual pain
Udwarthana; it has a greatrole owing to its Kaphahara and Medohara property[Trifalachurna best choice]
Rookshasweda; arthralgia and heaviness of body disappears …powder of kulatha,satahwa and methi can be used in kizhi
Yogasanas including suryanamaskar,pranayamas…
Lekhana Vasti;Very effectively controls kaphamedobahulya and over weight[3 to 5 vastis can be employed
Kapha medohara yogas:
Varunadhi kashaya
Gulguluthikthaka kashya
Kanchanara gulgulu
Kaisora gulgulu
Vyoshadi gulgulu
Gomutra haritaki
Ayaskrithi
Shilajit bhasmam
Shaddharana choornam
Dashamoolaharitaki etc..
LEKHANA VASTI (Su.S.Ci)
Makshikam 200ml
Saindhavam 15gms
Moorchita tailam 200ml
Kalkam yavanyadi 30 gms
Triphala kashyam 300 ml
Dhanyamlam 200 ml
Yavaksharam 10 gms
LEGHANAVASTI [simplified]
Trifala kashayam 150ml
Kulatha kashayam 150ml
Makshikam 150ml
Sneham[e.g.pippalyadi anuvasanam] 100ml
Kalkam-hinguvachadi churnam 30gms
Lavanam 10gms
Avapam -yavaksharam 10gms
Lekhana vasti has got sthoulya, kapha,medhohara property and brings up rookshana in system
VARUNADHI GANA is the most effective formulation when kapha medo vriddi, agni mandyam and adya vata symptoms are prominent .
Apathya :
Snehanam[ tailam internally is okay]
Abyangam
Ksheera , dadhi, ghee
Divaswapnam
Other Approachs:
Some of the veterans of Ayurveda consider concept of Pandu
and Kaphaja Pandu in treating hypothyroidism.
CASE REPORT; A 48 year old advocate came to me with following complaints
Puffiness,arthralgia.,overweight[recently]with lack of energy and somnolence’.[He was a known diabetic]
TFT was done which showed elevated TSH.
He was stared upon with udwarthana and rooksha sweda same day for 14 days8th 10th 12th day given lekhana vasti’matra vasti[3] in between
Varanadi,kanchanaragulgulu,pranada and kanmada bhasma internaly
From 5th day symptoms started receeding.He was totally asymtomatic in 21days.And to my surprise his chronic diabetis also got cure.He contd medicines for 2 months.
And after one year he developed all above which responded promptly to same procedures
HYPERTHYROIDISM
Presenting Symptoms are due to Hyper symphathetic activity and Hyper metabolic states.
Excess of circulating T4 & T3
Etiology:
Graves disease
Toxic MNG (mono nodular goiter)
Toxic adenoma
Symptoms of hyperthyroidism
Anxiety and irritability
Tremor and nervousness
Tachycardia
Feeling ‘’HOT’’ –heat intolerance
Voracious appetite
Fatigue
Weight loss
Diarrhoea( I have seen cases of hyperthyroidism presenting with diarrhea as the preliminary symptom)
Shorter menstrual periods
Exopthalmus
Hair loss
‘’Sweating’’ ( patients exibit excess of sweating even while sitting in air conditioned rooms while hypothyroid cases have no sweating at all even in heavy activity etc.)
Disturbed sleep
Skin - soft and moist
Note: in my clinical practice I have noticed that most of patients say that they like to take umbrella while going out and cant bear sun. while hypo-cases love to warm comforts.
We can relate above said symptoms with Doshas & Atyagni
Ativridha pitta lakshana
Vatavridhi lakshana
Atyagni roga samya
Pitta Symptoms
Voracious appetite
Feeling hot
Sweating
Diarrhoea
Irritability—krodha & eersha
Shorter menstrual periods-Lohita kshaya yoniroga
Disturbed sleep
Vata Symptoms
Anxiety , nervousness
Tremor
Tachycardia
Weight loss-Kaphakshaya=vatakopa
Fatigue
Atyagni –(Bhasmaka)
while going through the samprapti of atyagni (bhasmaka)
we can see that Kapha sosham, Pitta kopam takes place along with Vata anubandha and Stanasamsrayam happens at pachyamanasayam.
Jataragni gets blew up and burns food in no time; if enough food is not provided for the jataragni it burns up dhatus (Oxidative destruction) resulting in Extreme weakness, Thirst, burning sensation all over the body, difficulty in breathing (gasping) kasa, stupor eventually leading to death. Crisis of hyperthyroidism
(Thyrotoxicosis crisis) when left untreated results in death.
Agni :
In classics different aspects of agni is elaborately discussed
‘Aharam agnim pachati doshaan ahara varjita
Dhatun ksheeneshu dosheshu jeevitam dhatu samkshayet’
Agni --- aharam pachat
Agni --- doshan pachati
Agni --- dhatun pachati
Agni --- mrutyum anayati
The first 2 represents the constructive aspect and last 2 stands for the destructive aspects. We can say that the status of agni in hyperthyroidism is a destructive one like a wild fire.
MANAGEMENT
My first encounter with hyper thyroidism cases was in 1980’s.
I treated around 18 cases with the following combination and got symptomatic relief but no permanent cure was noted
Step 1:
Kashaya – special guloochyadi kashayam ( guloochyadi gana+ sariba, usheera, chandana & satavari)
Step 2:
Daadimadhi gritha- to be started after 21 days
Through trial and error I updated and revised my approach
Updated approach:
All the measures to bring down atyagni ,vitiated pitta,and controlling vata help to alleviate agony of hyperthyroid patients
Samana measures can easily reverse the burning issues of patients in short span of time.
Samana therapy
1. Pittahara kashaya… special guloochyadi, guloochyadi,drakshadi,vidaryadi etc
2. Thoyam –sariba,chandana,usheera
3. Ahara vidhi- of athyagni
4. Ghrita – Kalyanakam ( internally long term)- associated complaints like irritability, restlessness,insomnia etc can be tackled with this . Other pittahara ghritas have less effect on the above symptoms.
Sadya Virechana – optional ( depending on patients condition)
[1] Avipathhy choornam
[2] Ksheera kashyam of Trivrit,Syama
Special treatment –Talapothichil- [effective in excessive heat and burning sensation , insomnia and exopthalmus (to a little extend) ]. It should be done for 21 days and have to be repeated once in 2 months.
Snehapaana –(No swedana)
Virechana in Uthama Mathra
Note :
* Brinjal and Green gram effect:*
When patients were advised to include brinjal and green gram in their diet for specific time period, in most them the elevated thyroid levels came down and relief from symptoms were also noted. This is a folklore practice which need to be proved scientifically. So I advice this diet for maximum 3 weeks only.
ATYAGNI –LINE OF APPROACH IN MAJOR TREATISES
Main emphasis on food
Swadu , guru , kapha, medavardhaka
Mahisha ksheera, dadhi ,ghritha
FEEDBACKS
Moolakadikashayam
Hamsapathyadi kashayam
Nirgundadi oil—for head
line of treatment of Galaganda
CASE REPORT.
A male of 35 years on neomercasole and propanolol forhyperthyroidism in the last 3 years came to me to switch over to ayurveda.He had exopthalmus also.
He was started with guloochyadi kashayam b.d and kalyanaghritam simultaneously along with bhrimhana food. His neomercasole was withdrawn. From 3rd week propanolol whichwas meant to counter tachycardia was cut.He started responding from 2nd week.After 3 months only kalyanaghrita was maintained.He was advised bhrinjal and greengram food item for aweek every month.
Now 8 months are over .As he is coolie he couldnot be admitted for snehapana etc.
Dilemmas in Management
Alternating hypo and hyper thyroidism do exists in certain patients.
I have seen a diagnosed case from medical college recently.Doctors opined that one lobe shows hyper features while the other vice versa
A middle aged female who has been on neomercasole plus ……othr medicines came with arthragia and severe fatigue.I stopped all her moderndrugs all of asudden and started following medicines.
Varanadi ks ,trifalagulgulggulu,kanmada bhasma and kalyana ghrita hs
Here a combination of hypo and hyper medicines is done.She is on the above medicines and now asymptomatic.
CONCLUSION
Iam fully aware of limitations in my study.Only a selected group of hypo cases falls in to the criteria are benefitted.
Goitres thyroiditis,malignancies are not studied.
Hypo cases once recovered and having no medication for a year or more recurrence has seen.Ahara and vihara suitable to tackle kaphamedovridhi should be continued for a along run
Yet,I wish my humble attempt in this regard may stimulate earnest physicians to come up with newer approaches backed with trials.Even P.G.students can take this subject for research.
By
Dr.K.Padmanabhan M.D.
RTD.DMO[ISM]Wynad
dr_pappan@yahoo.com
(COURTESY APTA AUGUST 2012)
