Management of Hypothyroidism in Ayurveda
by Dr V V Lakshmi PrasunaFunction of Thyroid Gland and Hormone
Even up to 1880, the thyroid was proposed as a receptacle of worms, or even a vascular shunt, to cushion the brain against a sudden increase in blood flow. The definite function of the thyroid as a controller of metabolism was studied and confirmed by George Murray, Hector Mackenzie and Edward Fox .[1, 2, 3]The major function of the thyroid hormones is to stimulate the synthesis of protein once they have entered the cell nucleus. Another important function is to stimulate the activity of the cell's mitochondria. These intracellular organelles are the sites at which there is a controlled exchange of energy. Some energy is conserved for the body's functioning, while the remainder is dissipated as heat. The proportion of energy devoted to each of these processes is controlled by the thyroid hormones.[4]
In the Rig Veda {the first of a collection of sacred ancient Hindu texts) the first Rik starts with the 'agni meele purohitam' meaningagni is purohita, the conductor of rituals to protect the pura or this body.[6] The term agni means fire, which is a prime and ultimate factor in the maintenance of life. In vachaspatyam, agni is defined as 'nayate parinamayateeti' that which brings changes in an organism or a substance, indicating it is a key factor in transformation of consumed ahara viharadi dravyas of vijateeya(heterogeneous) origin into sajateeya (homogenous) nature. Since agni is a derivative of teja mahabhoota, it carries to paka in which the inherent feature is change. The term metabolism, which literally means change, is used to refer to all the chemical and energy transformations that occur in the body, which is nothing but the function of agni viz. 'Nayate parinaaamyateeti'.[6]
Hypothyroidism results when the thyroid gland fails to produce enough of the thyroid hormone, due to structural or functional impairment that significantly impairs its output of hormones - this leads to the hypo metabolic state of hypothyroidism. This tends to slow down the body's functions. The thyroid gland controls metabolism through the production of thyroid hormone. Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones.[7]Main Causes of Hypothyroidism
The main causes of hypothyroidism can be classified [8] into: 1. Primary (thyroid failure): Hypothyroidism, caused by the inability of the thyroid gland to make T3 and T4, 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 suprathyroid in origin. The most common cause of primary hypothyroidism is:
i) Iodine deficiency;
ii) AITDs (Autoimmune thyroid diseases);
iii) Drugs;
iv) Iatrogenic;
v) Congenital.
Transient hypothyroidism includes silent and part partum thyroiditis.
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 Parasthesias, muscle cramps, weakness, muscles stiffness and aching were the main complaints of the chronic cases.[9]
Ayurveda and the Thyroid Gland
There is no direct mention of the thyroid gland in Ayurveda, but a disease by the name Galaganda, characterized by neck swelling, is well known. The first description of neck swelling was mentioned in Atharva Veda (the last of the four Vedas) by the name apachi. Charaka mentioned the disease under 20 sleshma vikaras.[10] Sushruta {renowned ancient Indian surgeon}in Sareera Sthana has mentioned that of the seven layers of the skin, the sixth layer Rohini is the seat of Galaganda.[11] In Nidana Sthana he described Galaganda as two encapsulated small or big swellings in the anterior angle of the neck, which hang like scrotum, [12] whereas Charaka mentioned Galaganda as a solitary swelling.[13]The climatic conditions, water supply, dietary conditions, etc., are mentioned as the main aetiological factors. Susrutha stated that rivers flowing towards east might give rise to the occurrence of Galaganda.[14] Bhela described that Sleepda and Galaganda are more common in prachya desa (eastern part) of the country, and that persons consuming predominantly fish are liable to develop Galgaganda.[15] Harita Samhitakara described the role ofdustambu (contaminated water) and krimi dosha (infection) in the precipitation of Galaganda.[16] Kashyapa Samhitakara added that any part of the country that is cold, damp, with densely grown long trees, water stagnation and heavy rains may be prone for the development of Galaganda .[17]
A case of Galaganda attended with difficult respiration, a softening of the whole body, weakness, a non relish for, loss of voice, as well as the one which is more than of a year's standing should be abandoned by the physicians to be incurable.[18] Although these facts were mentioned centuries ago, it is still an accepted fact that environmental factors, especially iodine, plays an important role in the functioning of the thyroid gland. Any imbalance in iodine metabolism can upset the thyroid condition; either too much or too little iodine can result in the development of goitre. So the areas where the soil is depleted, also the soil content in which food grows, the drinking water and goitrogenic foods, play a vital role in disease process. As far as consuming fish or any seafood goes, all a rich source of iodine, an excess may be a causative factor.[19]
From the above description we can say that Galaganda is a condition related to thyroid gland. But hypothyroidism is not just a local disease; it has many symptoms related to many systems. So it is better not to restrict hypothyroidism with Galaganda as mentioned in the classics.Planning of Treatment
''Vikaranamakusalo na jihriyat kadachana Nahi sarva vikaranam namoto asti dhrivasthitih''.[20]- Cha Chi. 18/44
Ayurveda doesn't emphasize the exact nomenclature of the diseases; rather it insists on diagnosis of the constitutional status of the disease as mentioned in Charaka.[20]
Based on Ayurvedic principles, the following are the main causes for hypothyroidism.
- Genetical and hereditary defects come under Adibala Pravritta Vyadhis,[21] so no treatment is suggested;
- Congenital defects come under Janmabala Pravritta Vyadhis [21] (the disease present from birth itself, i.e. congenital defects). Thyroid gland Agenesis, Dysgenesis, Ectopic thyroid gland come under this category;
- Iodine deficiency is the main common cause for hypothyroidism. So 'Sarvadha sarva bhavanam samanyam vriddhikaranam'[22] applies here;
- Auto immunity is another common cause, so immuno modulatory drugs are recommended here;
- Side-effects of surgery and radiation: Kasta Sadhya [23] (difficult to treat);
- For transient hypothyroidism no specific treatment is required;
- If there is functional loss of thyroid tissue, or functional defects, thyroid stimulatory drugs are beneficial;
- Selection of drugs acting at various levels:[24]
'Samprapti vighatana' [6] is one of the main principles of treatment. Whatever may be the aetiology of the disease, it results in under-active condition of the thyroid gland and, ultimately, the slowing down of the body's metabolism. So the treatment should aim to stimulate the thyroid gland. Thyroid stimulatory drugs like Guggul should be selected to treat the disease.
- At Hypo-thalamo pituitary level: anti-stress drugs, Medhya Rasayana [25] drugs, Nasyakarma [25] may be beneficial;
- At thyroid gland level: thyroid stimulatory drugs are recommended here;
- At metabolism level: Deepana, Pacahana, Lekhana [25] drugs which pep-up body metabolism is recommended;
- Immuno modulatory drugs for autoimmune related hypothyroidism.
As symptoms of hypothyroidism are notorious, symptomatic treatment is based to suit individual cases, i.e. sthoulya (obesity), menstrual irregularities, etc.
Pathyapathya {Regimes to be followed during Treatments}
Eating goitrogenic foods such as rapeseed, cabbage, Brussels sprouts, broccoli, cauliflower, sweet potatoes, maize, lima beans, soya and pearl millet should be limited. These foods contain natural goitrogens, which are chemicals that cause the enlargement of the thyroid gland by interfering with thyroid hormone synthesis. Cooking is known to make the goitrogens elements less effective, but it would be wise not eat these foods raw.[27] Foods that contain iodine, such as kelp, beetroot, radish, parsley, potatoes, fish, oatmeal and bananas, should be kept in the diet.Vihara
Another important factor in the treatment of hypothyroidism is exercise. Exercise increases tissue sensitivity to the thyroid hormone, and stimulates thyroid gland secretion. An exercise regime of between 15-20 minutes per day benefits hypothyroidism. This exercise needs to be strenuous enough to raise the heartbeat, such as walking, swimming, running and cycling, except in the case of who also have generalized hypotonia, as they may be at risk of ligamental injury, particularly from excessive force across joints. Physical and emotional stress inhibits thyroid gland secretion due to reduction of thyrotrophin output. So reduction of stress is essential for proper functioning of the gland.Yoga [28]
Sarvangasana {shoulder stand}is the most suitable and effective asana for the thyroid gland. Enormous pressure is placed on the gland by this powerful posture. As the thyroid gland has a large blood supply, pressure has a dramatic effect on its function, improving circulation and squeezing out stagnant secretions. Also beneficial after Sarvangasanais the practice of Matsyasana (fish pose) and Halasna (plough pose). Other effective asanas include Surya Namaskara(Sun salutation), Pavanamuktasana (wind relieving pose) with emphasis on head and neck exercises, Supta Vajrasana(sleeping thunderbolt pose) and all backward bending asanas.Pranayam [28]
The most effective pranayama is ujjayi. It acts on the throat, and its relaxing and stimulating effects are most probably due to stimulation of ancient reflex pathways within the throat area, which are controlled by the brain stem and hypothalamus. Surya, Chandra, Nadi Sodhana pranayama (right, left and alternate nostril breathing) is useful in re-balancing metabolism.References
1. Prasuna VVL Dr. PG Scholar. Dept of Kaya Chikitsa under the guidance of Chander P Dr. Professor and HoD. PG Dept of Kaya Chikitsa. Dr BRKR Govt Ayurvedic College. Hyderabad. India. MD Thesis 2008. Clinical study on the effect of Kanchanara Guggulu and Shigru Patra Kwath on Hypothyroidism.2. Hudhes AF. A History of Endocrinology. Journal of the History of Medicine and Allied Sciences. 1977.
3. Felig P and Lawrence A. Endocrinology and Metabolism. Frohman. McGraw-Hill Professional. 2001.
4. Chutterjee CC. Human Physiology. Medical Allied Agency. Calcutta. India. 1988.
5. Best and Taylor. Physiological Basis of Medicinal Practice. 1974 edition.
6. Srinivasulu M Dr. Concept of Ama in Ayurveda. Chowkambha Sanskrit Series Office. Varanasi. India. 1992.
7. Shepard MC and Franklyn GA. Eds. Clinical Endocrinolgy and Diabetes. Churchill Livingston. 1988.
8. Davidson's principles and practice of medicine. Churchill Livingston. 17th edition. London. 1995.
9. Current Medical Diagnosis and Treatment. Prentice-Hall International. 1991.
10. Charaka. Charaka. Samhita Sutra Sthana. 20th chapter-17th sloka. V. Ramaswamy and Sons. Madras, India.
11. Sushruta. Sushruta Samhita (Sushruta Sareera Sthana.4/4).
12. Sushruta. Sushruta Samhita (Sushruta.Nidana11).
13. Charaka. Charaka Samhita (Charaka Chikitsa 11).
14. Sushruta. Sushruta Samhita (prachya nadi).
15 i)Bhela Samhita. "Sleepada galagandam cha prachysteshu drishyate." Bhela Samhita.
ii)Bhela Samhita. "Matsya anna bhojino nityam prachyaah syu kapha bittinah sleepdam galagandam cha prachya sastheshu drishyate."
16. Hareeta. Hareeta Samhita. "Dustambu panaka............krimijadosha ganasha gandat."
17. Kashyapa Samhita. Kashyapa Khila Sthana. 25th chapter.
18. Vagbhata, Astanga Hridayam, Chowkhamba Orientalia. 9th edition. 2002.
19. Harrisons Principles of Internal Medicine. 15th edition. McGraw-Hill Medical Publishing Division.
20. Charaka. Charaka Samhita Chikitsa Sthana. Vavilla Ramaswamy and Sons. Madras. India.
21. Sushruta Samhita. Sushruta Sutra Sthanam. 24th chapter-4th sloka.
22. Charaka. Charaka Sutra Sthanam. 3rd chapter.
23. Charaka. Charaka Sutra Sthanam. 10th chapter -17, 18 slokas.
24. Ayurvedic Conference on Disorders of Thyroid. Organized by Rashtreeya Ayurveda Vidya Peeth. National Academy of Ayurveda. Research Papers. 2001.
25. Dravya Guna Vijnan, Acharya Priyavrat Sharma, Chowkhambha Vidya Bhavan, and Varanasi. 1978.
a) Deepana: which stimulates agni;
b) Pachana: which helps in digestion;
c) Lekhana: which scrapes away unwanted impurities;
d) Rasayana: which ameliorates aging and disease;
e) Nasya: nasal application of medicine.
26. Vagbhta. Astanga Sangraha Nidana Sthana. 2nd chapter-4th sloka.
27. Prasuna VVL Dr. PG Scholoar. Professor and HoD. PG Dept of Kaya Chikitsa under the guidance of Chander P Dr. Dr BRKR Govt Ayurvedic College. MD Thesis.
Clinical study on the effect of Kanchanara Guggulu and Shigru Patra Kwath on Hypothyroidism. Hyderabad. India.
28. www.Ayurvedaforyou.com treatment of thyroid disorders.
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