A A M J Anveshana Ayurveda Medical Journal

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A A M J Anveshana Ayurveda Medical Journal www.aamj.in ISSN: 2395-4159 Review Article Hypothyroidism an Ayurvedic Perspective - A Critical Review Vidyashree 1 R.

Hypothyroidism is posing a major challenge both in developing as well as developed countries.

1 A A M J Anveshana Ayurveda Medical Journal ISSN: Review Article Hypothyroidism an Ayurvedic Perspective - A Critical Review Vidyashree 1 R. Shylaja Kumari 2 A b s t r a c t Thyroid hormone regulates the metabolic action of the body. Failure of thyroid hormone to meet the metabolic need of the body results in hypothyroidism. Hypothyroidism is posing a major challenge both in developing as well as developed countries.management of hypothyroidism in contemporary science is through hormonal supplement where in patients are bound to take it for the rest of life. Though popping in a pill is easy, it treats only the effect of the disease, and not the actual cause. So there is an urgent need of safe and effective Ayurvedic management. The proper understanding of pathogenesis of hypothyroidism as per the principles of Ayurveda is needed. This is the need to of the hour to find out exact cause of the disease, which once found, is easier to treat than treating it as an idiopathic. A disease may be the outcome of many etiological factors and a single causative factor can result in many diseases. The mode in which each and every etiological factor act in the manifestation of the disease is different. By considering all these factors the present study is aimed at understanding the etiology, pathology, signs and symptoms of hypothyroidism through Ayurveda. Key words: Thyroid hormone, Hypothyroidism, Etiology, Pathology. 1 PG Scholar, 2 Professor & Head, Department of PG Studies in Roganidana, Govt. Ayurveda Medical College, Bengaluru, Karnataka. CORRESPONDING AUTHOR Dr. VIDYASHREE PG Scholar, Department of PG Studies in Roganidana, Govt. Ayurveda Medical College, Bengaluru, Karnataka. vidyashree547@gmail.com AAMJ / Vol. 2 / Issue 3 / May June 2016

2 INTRODUCTION Today man has achieved high peaks in the field of medicine with the development of various techniques. However Ayurveda the ancient Indian system of medicine, which has its roots in Vedas, is still enjoying high profile in serving mankind. Man is the most precious creature on earth. Health is supreme foundation and diseases are destroyers of health. The interaction and exchange between Loka and Puruṣa continues in a natural way as the man breaths air, drink water and consume food articles available in nature. As long as this interaction is wholesome the man is in optimum health, when there is any set back in this harmonious relationship the disease state ensues. The changing life style of human being by means of nutritional and behavior pattern plays a major role in the manifestation of several disorders including hypothyroidism [i]. Hypothyroidism can result in from any of the abnormalities that lead to insufficient synthesis of thyroid hormones. Increasing trend of hypothyroidism is becoming more common in the present society and is more prevalent among the females. It is not only confined to metropolitan population but also extends to urban and rural areas. Ratio of disease occurrence among females & males is 6:1 and is usually found in number per thousand population (Davidson s) [ii]. In Ayurveda there is no clear cut evidence of hypothyroidism, but on the basis of its clinical presentation, it may be correlated with different of certain entities viz. Rasaja Vikāras, ja Nanatmaja Roga, Galagaṇḍa etc. diseases as well as the symptoms. Hence it is difficult to put a single Ayurvedic term for it. There are many systems which involve in the pathogenesis of hypothyroidism, the mixed signs and symptoms of all these systems lead to a complex clinical picture of hypothyroidism. In Ayurveda the disorders of thyroid gland are explained under the heading of Galagaṇḍa. By analyzing the symptomatology of hypothyroidism in the light of Ayurvedic literature, it is observed that hypothyroidism may be correlated with ja Galagaṇḍa as it occurs predominantly due to vitiation of Dośa and Rasa Dhatu (Sushruta). [iii] Hypothyroidism The thyroid gland is one of the most important endocrine glands affecting almost every system in the body. It is situated at the root of throat, having two lateral lobes each about cm, one on either side of trachea, joined by isthmus. The normal weight of thyroid gland in adult is gm. The thyroid gland produces three hormones viz. Thyroxine, Tri iodo thyroxin and Calcitonin. The major function of 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 cell mitochondria, the site of controlled exchange of energy. Some energy is conserved for the normal functioning of body while the remainder is dissipated as heat. The proportion of energy devoted to each of these processes is controlled by thyroid hormones. [iv] Physiological actions [v] Principle function of Thyroid gland is to act as catalyst for maintenance of Oxidative Metabolism (Increase of BMR) Thyroid hormones help in proper development during the foetal period and the first few months after birth. Necessary for normal growth, maturation and tissue differentiation. Accelerates energy production (Calorigenic) Regulates metabolism of carbohydrates, proteins, fats, calcium and phosphorus. Hypothyroidism is a common condition with various causes like Autoimmune, Iatrogenic, Transien Thyroiditis, Iodine Deficiency, Stressful life style, Drugs, Congenital, Infiltrative, Secondary Hypothyroidism. [vi] The clinical presentation depends on the duration and severity of the Hypothyroidism. A state of Hypothyroidism may be due to primary disease of the thyroid gland itself or lack of Pituitary TSH [Thyroid Stimulating Hormone] or Hypothalamic TRH [ Thyrotropine Releasing Hormone]. [vii] The signs and symptoms of Hypothyroidism at the initial stage are vague and ambiguous which is often missed in its early stages and instead treated for infertility, hyperlipidaemia, depression etc. In primary stage the signs and symptoms are in general but later on affect the different systems of the body and worsen the condition of patient. Hence, Hypothyroidism is an important public health issue [viii]. OBJECTIVES 1. To do conceptual study of hypothyroidism through Ayurvedic classics and modern medical text. 2. To analyse the etiopathogenesis of hypothyroidism through Ayurvedic point of view. AAMJ / Vol. 2 / Issue 3 / May June

3 MATERIALS AND METHODS This study is carried out by literature search and critical review of the obtained facts. The Pathogenesis of hypothyroidism is obtained by searching various medical research databases like PubMed, Google scholar, Embase and other national research databases. The study of various Ayurvedic texts were made critically and an effort is made to understand the pathogenesis of hypothyroidism. OBSERVATION & DISCUSSION There is no direct mention of Thyroid gland and Hypothyroidism in Ayurveda. However, a disease named Galagaṇḍa, characterised by neck swelling is well known. Aacharya Charaka has included it under 20 Śleṣma Vikāra [ix]. Aacharya Sushruta has mentioned the seat of Galagaṇḍa as Rohini Twacha, the sixth layer of skin [x]. Charaka described it as a solitary swelling [xi] while Sushruta has mentioned it as two encapsulated, big or small swelling, hanging like scrotum, in the anterior angle of neck [xii]. Bhela describes Ślīpada and Galagaṇḍa are more common in Prachya Desha (eastern parts of country) and that of consumption of fish predominantly are liable to develop Galagaṇḍa. Harita has described the role of Dushtambu (contaminated water) and Krimi Dośa (infections) in the precipitation of disease. Kashyapa has further added that regions that are cold, damp, with densely grown trees, water stagnation and heavy rains may be prone for Galagaṇḍa [xiii]. Although these facts are mentioned centuries ago, it is still an accepted fact that environmental factors, especially iodine, plays an important role in the functioning of thyroid gland. From the above description, Galagaṇḍa can be correlated with the Simple Goitre, the non- inflammatory, non neoplastic condition of thyroid gland. It is observed both in hypothyroidism and hyperthyroidism. Any imbalance in iodine metabolism, either too much or too little iodine can result in development of goitre. Goitre is a localised condition but hypothyroidism is related to many systems of the body. Aetiology of Hypothyroidism Hypothyroidism is caused by inadequate function of the thyroid gland itself called primary hypothyroidism or by not getting enough stimulation by thyroid stimulating hormones called secondary hypothyroidism. Primary hypothyroidism is caused by iodine deficiency, autoimmune disease, radiation therapy, drugs or thyroid surgery. [xiv] So far Ayurvedic Nidāna (Causes) is concerned the etiological factors related to - Prakopaka, Agnimandya Janaka and Rasapradośaka Nidāna will may be responsible for the genesis of hypothyroidism [xv]. Clinical Presentation of Hypothyroidism Hypothyroidism results from failure of thyroid gland to produce enough thyroid hormones to meet the metabolism of body or from resistance of peripheral tissue to thyroid hormone. Hypothyroidism results in slowing of metabolic process and energy expenditure. Hypothyroidism usually results in a multitude of clinical signs and symptoms. The degree of thyroid dysfunction and the time course of development of hypothyroidism determine the severity of manifestations. The symptoms of hypothyroid are very nonspecific. However common presentations of hypothyroidism along with its Ayurvedic perspective are tabulated below; [xvi,xvii,xviii & xix] Symptoms and Signs of Hypothyroidism: Symptom/Sign Dośa Involved Srotas [xx, xxi] Involved fatigue, loss of energy, Rasavaha Lethargy, Sleepiness Rasavaha Weight gain Rasavaha Decreased appetite Rasavaha Cold intolerance, Hypothermia (only in severe hypothyroid states) Annavaha Dry skin Rasavaha Hair loss, Coarse, brittle, straw-like hair, Loss of scalp hair, axillary hair, pubic hair, or a combination Muscle pain, joint pain, weakness in the Extremities Dull facial expression, Depression, Emotional liability, mental impairment, Forgetfulness, impaired memory, inability to concentrate Hypo-reflexia with delayed relaxation, ataxia, or both Asthivaha Asthivaha, Mamsavaha Manovaha Raktavaha, Manovaha Constipation Purishavaha Menstrual disturbances, impaired fertility Artavavaha, Sukravaha Fullness in the throat, hoarseness Pranavaha Jaundice, Pallor Bradycardia, Decreased systolic blood pressure and increased diastolic blood pressure Pericardial effusion, Abdominal distention, ascites (uncommon), Non-pitting edema (myxedema), Pitting edema of lower extremities Goiter (simple or nodular) Pitta RasavahaRaktavaha Raktavaha Mamsavaha, Medovaha AAMJ / Vol. 2 / Issue 3 / May June

4 From the above table it is clear that in hypothyroidism there is abnormality of Jatharagni and Dhatwagni along with abnormality of and Dośa as well as Raktavaha, Medovaha, Sukravaha and Manovaha Srotas. Cardiac function and cardiovascular hemodynamics is readily regulated by the thyroid hormone T3. Hypothyroidism causes decreased cardiac contractility and cardiac output as well as increased peripheral resistance. [xxii]. These findings may indicate morbidity of Rasavaha Srotas in hypothyroidism. Hypothyroidism patients show increased carotid artery intimamedia thickness due to artherosclerosis, and elevated total cholesterol, elevated high density lipoprotein which improve on hormone replacement therapy. [xxiii] In cases of overt hypothyroidism the serum triglycerides remain high and the high density lipoprotein level remain low. [xxiv] These facts support the abnormality of Medovaha Srotas in the pathogenesis of hypothyroidism. Some Study show that hypothyroidism shows mild decrease in seminal volume, mild decrease in progressive forward motility of sperm and mild decrease in cumulative percentage of mobile forms of sperm. [xxv] Hypothyroid phase of hypothyroidism displays hypergonadotropism, low serum testosterone and subnormal testosterone response to human chorionic gonadotripism and these abnormalities revert back on thyroxin substitution. [xxvi] These facts support involvement of Sukravaha Srotas in hypothyroidism. Elderly patient with hypothyroidism have low Mini-Mental State Examination score than euthyroid counterpart. [xxvii] Hypothyroidism is known to induce various neurological and mental dysfunctions [xxviii] which supports Manovaha Srotas abnormality in this Rogamarga: Abhyantara(Kostha), Agni :Mandya: Ama :JatharAgni Mandya Janita, Dhatvagni Jaita. Rasa-Rakta During the treatment of hypothyroidism these pathogenetic factors has to be targeted with special attention to strength of body, mind, and Dośa. ΛΛΛΛ disorder. Principle of treatment The line of treatment with specific target to Mamsavaha, Medovaha, Manovaha Srotas as well as Dośa should be administered in Hypothyroidism. The few Ayurvedic drugs commonly used in practice are Tinospora cordifolia, Aswagandha, Silajit, Guggulu, etc CONCLUSION Although the disease hypothyroidism is not described in classical Ayurvedic texts. Based on its clinical presentation its Samprapti (pathogenesis) can be understood as follows; Dośa-,, Dushya-Rasa, Meda, Mamsa, Asthi, Majja, Sukra, Samuththana-Amasaya, Adhisthana-Sarva Sareera, Srotodushti- Sanga, AAMJ / Vol. 2 / Issue 3 / May June

5 REFERENCES i. Hypothyroidism%20-%20Wikipedia,%20the%20free%20encyclopedia.htm ii. Davidson sprincipes and Practise of Medicine 20th edition chapter 20 Page no.746 iii. Charak samhita-elaborated vidyotini hindi commentary part-2,by Pt. Kashinath Panday & Dr. Gorakhnath Chaturvedi, Chaukhambha Bharti Academy, Varanasi, 2013, Chikitsa Sthana, Chapter-12. iv. Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Harrison s Principles of Internal Medicine. 17 th edition, United States of America, RR Donnely & Sons company Vol 2 Page v. vi. Stanley Davidson. In: Colledge NR, Waller BR, Ralston SH, (eds.) Davidson s Principles and Practice of Medicine. 16th edi. U.K.: Churchill Livingstone Elsevier; Page 741. vii. Krupp MA, Chatton MJ, Werdegar D. In: (eds.) Current medical diagnosis & treatment st edi.singapore: Lange medical publications, USA; Page 703. viii. ix. Charaka Samhita, Edited by Dr.Brahmanand Tripathi, Chaukhambha Surbharati Prakashan, Varanasi, Reprint Edition 2009 Sutra Sthana, Maharoga Adhyaya, 20/17. Page no. 395 x. Sushruta Samhita, Edited by Dr. Ambikadatt Shastri, Chaukhambha Sanskrit Samsthan, Varanasi, 9 th Edition, 2051 Sharira Sthana, Garbhavyakaran Sharir Adhyaya, 4/4. Page no. 37 xi. Charaka Samhita, Edited by Dr.Brahmanand Tripathi, Chaukhambha Surbharati Prakashan, Varanasi, Reprint Edition 2009 Chikitsa Sthana, Swayathuchikitsa Adhyaya, 12/79. Page no. 459 xii. Sushruta Samhita, Edited by Dr. Ambikadatt Shastri, Chaukhambha Sanskrit Samsthan, Varanasi, 9 th Edition, 2051 Nidana Sthana, GranthyapachyarbudaGalagaṇḍanam Adhyaya, 11/29. Page no. 356 xiii. Vridha Jiwak Tantra, Kasyapa Samhita, Edited by Proff. P.V. Tiwari, Chaukhambha Vishwabharti, Varanasi, 1st Edition, 1996 Khil Sthana,25/10. Page no. 387 xiv. Díez JJ. Hypothyroidism in Patients Older Than 55 Years An Analysis of the Etiology and Assessment of the Effectiveness of Therapy. J Gerontol A Biol Sci Med Sci May 1;57(5):M xv. Orlander PR, Griffing GT, Varghese JM, Freeman LM. Hypothyroidism Clinical Presentation [Internet]. Medscape, Drugs & Disease. Available from: clinical xvi. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol Dec;18(6): xvii. Saito I, Ito K, Saruta T. Hypothyroidism as a cause of hypertension. Hypertension Jan 1;5(1): xviii. Duyff RF, Bosch JV den, Laman DM, Loon B-JP van, Linssen WHJP. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry Jun 1;68(6): xix. Charaka Samhita of Agnivesha elaborated by Charaka Chakrapani dutta, Sutrasthana, Chapter- 20, Verse No- 11,12,17,18, Page Edited by: Vaidya Jadavji Trikamji Acharya Published by Choukhambha Surbharati Prakashan, Varanasi Edition Reprint 2005, Sloka No: xx. Charaka Samhita of Agnivesha elaborated by Charaka Chakrapani dutta, Sutrasthana, Chapter- 28, Verse No-9-22, Page-179 Edited by: Vaidya Jadavji Trikamji Acharya Published by Choukhambha Surbharati Prakashan, Varanasi Edition Reprint xxi. Charaka Samhita of Agnivesha elaborated by Charaka Chakrapani dutta, Sutrasthana, Chapter- 24, Verse No 25-27, Page-125 Edited by: Vaidya Jadavji Trikamji Acharya Published by Choukhambha Surbharati Prakashan, Varanasi Edition Reprint xxii. S D, I K. Thyroid hormone and the cardiovascular system. Minerva Endocrinol Sep;29(3): xxiii. Monzani F, Caraccio N, Kozàkowà M, Dardano A, Vittone F, Virdis A, et al. Effect of Levothyroxine Replacement on Lipid Profile and Intima-Media Thickness in Subclinical Hypothyroidism: A Double-Blind, Placebo- Controlled Study. J Clin Endocrinol Metab.2004 May;89(5): xxiv. Abdel-Gayoum AA. Dyslipidemia and serum mineral profiles in patients with thyroid disorders. Saudi Med J Dec;35(12): xxv. Hernández JJC, García JMM, García Diez LC. Primary Hypothyroidism and Human Spermatogenesis. Syst Biol Reprod Med Jan 1;25(1):21 7. xxvi. Kumar J, Khurana ML, Ammini AC, Karmarkar MG, Ahuja MMS. Reproductive Endocrine Functions in Men with Primary Hypothyroidism: Effect of Thyroxine Replacement. Horm Res. 1990;34(5-6): xxvii. Ceresini G, Lauretani F, Maggio M, Ceda GP, Morganti S, Usberti E, et al. Thyroid Function Abnormalities and Cognitive Impairment in Elderly People: Results of the Invecchiare in Chianti Study: THYROID FUNCTION, AG- ING, AND COGNITION. J Am Geriatr Soc Jan;57(1): xxviii. Monzanil F, Guerra PD, Caracciol N, Pruneti CA, Puccil E, Luisit M, et al. Subclinical hypothyroidism: neurobehavioral features and beneficial effect of l-thyroxine treatment. Clin Investig May 1;71(5): Source of Support: Nil. Conflict of Interest: None declared How to cite this article: Vidyashree & Shylaja Kumari : Hypothyroidism an Ayurvedic Perspective - A Critical Review AAMJ 2016; 3: ΛΛΛΛ AAMJ / Vol. 2 / Issue 3 / May June

AYUSHDHARA. An International Journal of Research in AYUSH and Allied Systems. Review Article

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