AN AYURVEDIC APPROACH TO THE MANAGEMENT OF HYPOTHYROIDISM

Thyroid gland is one of the most important and sensitive endocrine gland which easily responds to stress and stimuli, so the global incidence of hypothyroidism is increasing day by day.When the thyroid gland is under active, improperly formed at birth, surgically removed all or in part, or becomes incapable of producing enough thyroid hormones, a person is said to be hypothyroid. Usually this disease runs a chronic course.

                        It is estimated that 200 million of the world population suffers from thyroid disorders.. Females are more likely to get Hypothyroidism than males – ratio 6:1. 80% of all thyroid disease cases are diagnosed as Hypothyroidism and 20% Hyperthyroidism.

                        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.

Anatomy of thyroid gland

                        Thyroid gland is situated in the lower part of the neck, anterior to the trachea, between the Cricoid cartilage and the Suprasternal notch, deep to the Sternothyroid and Sternohyoid muscles.  It is highly vascular and soft in consistency. It’s weight is about 30 grams, and has a bow tie shape. It is asymmetric, and is usually larger in the women than men, and it enlarges during puberty, in pregnancy, during lactation and in the latter part of the menstrual cycle.

Physiology of thyroid gland

                                    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 Triiodothyronine (T3)

Biological Effect

                        The thyroid gland is involved in variety of Biological effects in the body like Growth and development, Energy metabolism, Nervous system ( alertness & mood ), Heart functioning (rate ), Musculo-Skeletal system, Caloric metabolism, Respiratory system ,Skin, Colon (constipation ), Sex, Vitamins ,Carbohydrate, Calcium ,Phosphorous  & Protein metabolism

Role of Iodine and Selenium 

                        Iodine accounts for 65% of the weight of T4. Too little of iodine causes mental retardation, goitre, and other features of the so-called iodine deficiency disorders. Selenium is required for a number of enzymes known as seleno proteins needed in the chemical reactions, which converts thyroid hormone T4 into T3. Selenium deficiency can impair thyroid function

Signs and Symptoms

                        Hypothyroidism has been called the “great imitator” for the vast number of medical conditions it can mimic. It causes decreased mental and physical activity, cold intolerance, weight gain, vague generalized pains, forgetfulness, absence of sweat, sparse and lusterless hair, low monotonous husky speech, dryness of the skin, constipation, tiredness and menstrual irregularities etc..

Primary Hypothyroidism - An Ayurvedic Approach

It can be mainly considered under

—  Agni  Dushti

—  Kaphaja Nanatmaja Vyadhi & Medo dushti

—  Ashtou Nindita Purushas

—  Galaganda

1)      Agni  Dushti

                        The study pertaining to the physiology of thyroid gland reveals that it controls all most all the metabolic activities of the body, which according to Ayurveda are the functions attributed to Agni, one of the great concepts of Ayurveda. Jataragni and Dhatwagni vyapara closely resembles to that of metabolic activities of the thyroid hormones.

                        When the Agni, under the influence of kapha dosha, is not able to metabolize even small quantity of easily digestible food then mandagni is said to prevail. Ayurveda states that it is the mandagni which is the root cause for all the disorders. This is true in the case of primary Hypothyroidism also. Chakrapanidatta opines that any anomalies in agni lead to either mal-nourishment or excess nourishment of the dhatus leading to apachaya or upachaya of the body.

2)      Kaphaja Nanatmaja Vyadhi & Medo dushti

                        There is a Vrudhi of kapha dosha and Kshaya of Vata dosha .Involvement of meda, mamsa and rasa dhatu predominantly. There is abnormal state of dhatwagni of meda and mamsa dhatus.  It is worth noticeable that majority of the kaphaja nanatmaja vyadhis are co-related with the signs and symptoms of hypothyroidism. It seems that the hypothyroidism is a syndrome (lingasankara) caused by the vitiation of kapha dosha and dhatwagnis.

                        The impaired fat metabolism causes accumulation of muco poly saccharides below the skin causes puffy appearance and obesity. In Ayurvedic view, these materials can be compared with abadha medas, which occur due to the medo dhatwagni mandyam. 

3)      Ashtou Nindita Purushas

                        This can be described on the basis of various hormonal disorders. Though hypothyroidism as such is not mentioned in Ayurveda, many conditions of it have been described in our classics.

4)      Galaganda

                        The earliest description of neck swelling is found in atharva veda by the name apachi. Charakacharya first described about the disease Galaganda. He mentioned this in sutra sthana 20th chapter (maharogadhayaya) under the 20 varieties of sleshma vikaras. Susuthacharya has described that out of seven layers of the skin, the sixth layer known as ‘’Rohini’’ is responsible for the development of Galaganda.

Treatment protocol for hypothyroidism

                        Basic line of treatment is to tackle Kapha, Medo Vrudhi. Measures to kindle Jataragni should be our main aim while treating hypothyroidism. As Jataragni is low and appetite poor, patient should be advised for Upavasa or to cut atleast supper & stick on Kaphahara ahara. Panchakola Jala acts as Deepana and Pachana. It also relieves menstrual pain.

                        Various Kapha-Medo hara Bahya prayogas can be done. For Udwarthana Triphala choorna is a good choice.  For Rooksha Sweda Kulatha, Satahva and Methi can be used in Kizhi. Shodhana procedures like Lekhana Vasti, Vamana, and Nasya can be done. Regular Vyayama for 15 to 20 minutes, Yogasanas like Sarvangasana, Matsyasana, Halasana, and Suryanamaskara can be done along with Ujjayi Pranayama. Varanadi gana is the most effective formulation when kapha medo vriddi, agni mandyam and adya vata symptoms are prominent

                        The use of Kanchanara, Guggulu, and Shigru Patra is also important. The action of Kanchanara in cases of goitre is most probably by its Prabhava (gandamalanashak) & not merely by rasa, Guna, veerya or Vipaka. Guggulu acts as rasayana, anti-inflammatory, cuts down cholesterol & aphrodisiac which are all very beneficial in hypothyroid conditions. Guggulsterone increases iodine uptake. Shigru leaves are rich in iodine; iodine deficiency is supplemented by administering the drug which contains iodine.

Pathya- Apathya

                        The diet should be high in fibre and low in calorie. Foods that contain iodine such as kelp, beetroot, radish, parsley, potatoes, fish, oatmeal and bananas should be kept in the diet

            Avoid salted confectioneries, chips and pickles. Eating goitrogenic foods such as cabbage, brussels sprouts, broccoli, cauliflower, sweet potatoes, maize, lima beans, soya and pearl millet should be limited. Avoid caffeine drinks like coffee, cola.